Provider Demographics
NPI:1194003285
Name:RODRIGUEZ, VIRGINIA
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6609 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-1709
Mailing Address - Country:US
Mailing Address - Phone:773-209-2035
Mailing Address - Fax:312-770-2557
Practice Address - Street 1:1127 N OAKLEY BLVD FL 3
Practice Address - Street 2:1431 N CLAREMONT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3507
Practice Address - Country:US
Practice Address - Phone:312-770-3049
Practice Address - Fax:312-770-2557
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health