Provider Demographics
NPI:1366566051
Name:RODRIGUEZ, JOSEPH M
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RICHARDS DR
Mailing Address - Street 2:APT. #304
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19804-3245
Mailing Address - Country:US
Mailing Address - Phone:302-743-0558
Mailing Address - Fax:302-743-0558
Practice Address - Street 1:500 W 10TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801-1422
Practice Address - Country:US
Practice Address - Phone:302-984-2302
Practice Address - Fax:302-984-3380
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE484101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)