Basic Information
| Provider Information | |||||||||
| NPI: | 1417494899 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | EMMA | ||||||||
| MiddleName: | GRACE | ||||||||
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| Credential: | L.S.W | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5109 W BROAD ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432281648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142797690 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5109 W BROAD ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43228 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142797690 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2017 | ||||||||
| LastUpdateDate: | 07/19/2018 | ||||||||
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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 | 104100000X | S.1700005 | OH | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.