Basic Information
Provider Information
NPI: 1003142233
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RODRIGUEZ
FirstName: JOSE
MiddleName: ANGEL
NamePrefix: MR.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 W 97TH ST
Address2: C/O WILLIAM F. RYAN COMMUNITY HEALTH CENTER
City: NEW YORK
State: NY
PostalCode: 100256450
CountryCode: US
TelephoneNumber: 2127491820
FaxNumber: 2129328323
Practice Location
Address1: 305 EAST 161ST
Address2: C/O MONTEFIORE
City: BRONX
State: NY
PostalCode: 10451
CountryCode: US
TelephoneNumber: 7184103561
FaxNumber: 7184103629
Other Information
ProviderEnumerationDate: 10/22/2009
LastUpdateDate: 06/21/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP1600X NYN Behavioral Health & Social Service ProvidersCounselorPastoral
1041C0700X081480NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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