Provider Demographics
NPI:1063777332
Name:RODRIGUEZ, LORRAINE DENISE (TSHH)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:DENISE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PALISADE AVE
Mailing Address - Street 2:5J
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-1541
Mailing Address - Country:US
Mailing Address - Phone:917-975-2170
Mailing Address - Fax:
Practice Address - Street 1:840 PALISADE AVE
Practice Address - Street 2:5J
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-1541
Practice Address - Country:US
Practice Address - Phone:917-975-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY521206041171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor