Basic Information
| Provider Information | |||||||||
| NPI: | 1992008981 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | NATIVIDAD | ||||||||
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| Credential: | LABA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 TURIN RD # 2 | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 016041825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2695989989 | ||||||||
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| Practice Location | |||||||||
| Address1: | 132 ROBBS HILL RD | ||||||||
| Address2: | |||||||||
| City: | LUNENBURG | ||||||||
| State: | MA | ||||||||
| PostalCode: | 014622167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742701766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2010 | ||||||||
| LastUpdateDate: | 05/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 103K00000X | 2065 | MA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.