Provider Demographics
NPI:1104786318
Name:RODRIGUEZ, NATALIE LIANA (LSW)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:LIANA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9-15 BERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1722
Mailing Address - Country:US
Mailing Address - Phone:551-804-6402
Mailing Address - Fax:
Practice Address - Street 1:9-15 BERDAN AVE
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1722
Practice Address - Country:US
Practice Address - Phone:551-804-6402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07334600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty