Provider Demographics
NPI:1063894897
Name:RODRIGUEZ, KARLY (LMHC)
Entity type:Individual
Prefix:MS
First Name:KARLY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 CAMBRIDGE AVE APT 6J
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-3631
Mailing Address - Country:US
Mailing Address - Phone:201-966-7873
Mailing Address - Fax:
Practice Address - Street 1:170 W END AVE APT 1K
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5450
Practice Address - Country:US
Practice Address - Phone:646-633-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty