Provider Demographics
NPI:1124492038
Name:RODRIGUEZ, CHASITY ANGELITA (MSW)
Entity type:Individual
Prefix:MS
First Name:CHASITY
Middle Name:ANGELITA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NOBLE AVE
Mailing Address - Street 2:APT 3O
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-1418
Mailing Address - Country:US
Mailing Address - Phone:804-938-3632
Mailing Address - Fax:
Practice Address - Street 1:1419 SHAKESPEARE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1851
Practice Address - Country:US
Practice Address - Phone:171-873-2708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7211008A251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141397918Medicaid