Provider Demographics
NPI:1063622603
Name:RODRIGUEZ, GISELA NELIA (MSW)
Entity type:Individual
Prefix:MS
First Name:GISELA
Middle Name:NELIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 BEAUMONT PL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-1702
Mailing Address - Country:US
Mailing Address - Phone:973-485-8502
Mailing Address - Fax:973-972-3310
Practice Address - Street 1:90 BERGEN ST
Practice Address - Street 2:SUITE 5400
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-3300
Practice Address - Fax:973-972-3310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC102681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical