Provider Demographics
NPI:1285083691
Name:RODRIGUEZ, MILDRED (LCSW)
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5803 NW 151ST ST STE 200B
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2473
Mailing Address - Country:US
Mailing Address - Phone:646-374-6451
Mailing Address - Fax:305-529-9119
Practice Address - Street 1:717 PONCE DE LEON BLVD STE 307
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2070
Practice Address - Country:US
Practice Address - Phone:305-952-3247
Practice Address - Fax:305-952-3248
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-07
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY0756011041C0700X
FLSW164331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health