Basic Information
| Provider Information | |||||||||
| NPI: | 1821375213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | LILLIAM | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23 HARRIS ST | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068502031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9547409662 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 SW 27TH AVE | ||||||||
| Address2: | SUITE G20 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056437800 | ||||||||
| FaxNumber: | 3056431345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2011 | ||||||||
| LastUpdateDate: | 06/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 022499 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.