Provider Demographics
NPI:1285732594
Name:RODRIGUEZ, SONIA IVELISSE (MASTER)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:IVELISSE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND.PLAZA DEL PARQUE APT.T-4
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-283-6072
Mailing Address - Fax:787-783-0686
Practice Address - Street 1:D12 CALLE BUEN SAMARITANO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-2025
Practice Address - Country:US
Practice Address - Phone:787-783-0610
Practice Address - Fax:787-783-0686
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR26711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical