Provider Demographics
NPI:1124805163
Name:RODRIGUES, DENISE (LSW)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:RODRIGUES
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 1:41 MASON ST
Mailing Address - Street 2:
Mailing Address - City:LAKE HOPATCONG
Mailing Address - State:NJ
Mailing Address - Zip Code:07849-1212
Mailing Address - Country:US
Mailing Address - Phone:201-572-5480
Mailing Address - Fax:
Practice Address - Street 1:1 KALISA WAY STE 211
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-3538
Practice Address - Country:US
Practice Address - Phone:914-529-7010
Practice Address - Fax:201-652-6253
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07022000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL07022000OtherLICENSED SOCIAL WORKER