Provider Demographics
NPI:1225379704
Name:RODRIGUEZ, BRENDA L (MFT)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SAWYER WAY
Mailing Address - Street 2:
Mailing Address - City:WALLKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12589-2660
Mailing Address - Country:US
Mailing Address - Phone:646-648-3392
Mailing Address - Fax:
Practice Address - Street 1:50 CENTER ST
Practice Address - Street 2:
Practice Address - City:ELLENVILLE
Practice Address - State:NY
Practice Address - Zip Code:12428-1315
Practice Address - Country:US
Practice Address - Phone:845-647-3349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP87292106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist