Provider Demographics
NPI:1710708250
Name:RODRIGUEZ, LISSETTE (MS)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URBANIZACION VICTORIA CALLE AZUCENA CASA # 3
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603
Mailing Address - Country:US
Mailing Address - Phone:787-974-6344
Mailing Address - Fax:
Practice Address - Street 1:URBANIZACION VICTORIA CALLE AZUCENA CASA # 3
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-974-6344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR136501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical