Basic Information
| Provider Information | |||||||||
| NPI: | 1437677937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUES | ||||||||
| FirstName: | GUADALUPE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22011 92ND AVE | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114281356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3479220731 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11515 SUTPHIN BLVD | ||||||||
| Address2: | |||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114341020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186594000 | ||||||||
| FaxNumber: | 7186591405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2017 | ||||||||
| LastUpdateDate: | 08/31/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 105329 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.