Provider Demographics
NPI:1194292417
Name:RODRIGUEZ, NITZA IVETTE (LMFT)
Entity type:Individual
Prefix:
First Name:NITZA
Middle Name:IVETTE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WILLOW POND WAY STE 103
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-385-6030
Mailing Address - Fax:
Practice Address - Street 1:21 WILLOW POND WAY
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-385-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000881101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor