Provider Demographics
NPI:1194526137
Name:RODRIGUEZ, OLGA NOEMI (LIC)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:NOEMI
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:LIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:
Mailing Address - City:AGUAS BUENAS
Mailing Address - State:PR
Mailing Address - Zip Code:00703-0470
Mailing Address - Country:US
Mailing Address - Phone:939-261-4444
Mailing Address - Fax:
Practice Address - Street 1:CALLE LUIS MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO 105
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703
Practice Address - Country:US
Practice Address - Phone:939-261-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-24
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3654103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty