Provider Demographics
NPI:1063955722
Name:RODRIGUEZ BERRIOS, MAITE ANGELIE (MS, PCC, NBC-HWC)
Entity type:Individual
Prefix:
First Name:MAITE
Middle Name:ANGELIE
Last Name:RODRIGUEZ BERRIOS
Suffix:
Gender:F
Credentials:MS, PCC, NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1455
Mailing Address - Country:US
Mailing Address - Phone:630-387-9141
Mailing Address - Fax:
Practice Address - Street 1:703 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1455
Practice Address - Country:US
Practice Address - Phone:630-387-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No174400000XOther Service ProvidersSpecialist
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty