Provider Demographics
NPI:1104606847
Name:RODRIGUEZ ROGERS, AMANDA LEAH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEAH
Last Name:RODRIGUEZ ROGERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:LEAH
Other - Last Name:RODRIGUEZ-TEUTONICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2182 STATE ROUTE 29 HWY
Mailing Address - Street 2:
Mailing Address - City:HUNLOCK CREEK
Mailing Address - State:PA
Mailing Address - Zip Code:18621-4512
Mailing Address - Country:US
Mailing Address - Phone:570-239-8052
Mailing Address - Fax:
Practice Address - Street 1:2182 STATE ROUTE 29 HWY
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-4512
Practice Address - Country:US
Practice Address - Phone:570-239-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional