Basic Information
Provider Information | |||||||||
NPI: | 1467614453 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RODRIGUEZ | ||||||||
FirstName: | CLARA | ||||||||
MiddleName: | ISABEL | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW-R | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CERDA | ||||||||
OtherFirstName: | CLARA | ||||||||
OtherMiddleName: | ISABEL | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LMSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 481 MAIN ST STE 403 | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108016360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9143552440 | ||||||||
FaxNumber: | 9142350822 | ||||||||
Practice Location | |||||||||
Address1: | 481 MAIN ST STE 403 | ||||||||
Address2: |   | ||||||||
City: | NEW ROCHELLE | ||||||||
State: | NY | ||||||||
PostalCode: | 108016360 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9143552440 | ||||||||
FaxNumber: | 9142350822 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/30/2008 | ||||||||
LastUpdateDate: | 07/09/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 076772 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.