Provider Demographics
NPI:1093946113
Name:RODRIGUEZ, LIZA MICHELLE (TS)
Entity type:Individual
Prefix:MRS
First Name:LIZA
Middle Name:MICHELLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:TS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AO18 CALLE 14
Mailing Address - Street 2:URB VALENCIA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-3701
Mailing Address - Country:US
Mailing Address - Phone:787-464-7464
Mailing Address - Fax:787-461-7335
Practice Address - Street 1:URB VALENCIA
Practice Address - Street 2:AO18 CALLE 14
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959
Practice Address - Country:US
Practice Address - Phone:787-464-7464
Practice Address - Fax:787-461-7335
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15772104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker