Provider Demographics
NPI:1275332124
Name:RODRIGUES, ALEX (PSYD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:RODRIGUES
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-3515
Mailing Address - Country:US
Mailing Address - Phone:631-806-6117
Mailing Address - Fax:
Practice Address - Street 1:5046 MEADE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-1034
Practice Address - Country:US
Practice Address - Phone:631-806-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1000947103TF0200X
MD05606103TF0200X
VA0810005165103TF0200X
NJ35SI00597300103TF0200X
COPSY000.4805103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic