Provider Demographics
NPI:1194764241
Name:RODRIGUEZ-DIAZ, ANGELINA
Entity type:Individual
Prefix:MRS
First Name:ANGELINA
Middle Name:
Last Name:RODRIGUEZ-DIAZ
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 1:15 WICASSEE RD
Mailing Address - Street 2:
Mailing Address - City:TYNGSBORO
Mailing Address - State:MA
Mailing Address - Zip Code:01879-1529
Mailing Address - Country:US
Mailing Address - Phone:978-649-3019
Mailing Address - Fax:
Practice Address - Street 1:99 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2621
Practice Address - Country:US
Practice Address - Phone:978-458-6282
Practice Address - Fax:978-441-9826
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical