Provider Demographics
NPI:1306453287
Name:RODRIGUEZ, IRIS NANCY
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:NANCY
Last Name:RODRIGUEZ
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:IRIS RODRIGUEZ
Mailing Address - Street 2:2094 PITKIN AVENUE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3509
Mailing Address - Country:US
Mailing Address - Phone:718-240-0614
Mailing Address - Fax:718-240-0601
Practice Address - Street 1:IRIS RODRIGUEZ
Practice Address - Street 2:2094 PITKIN AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-3509
Practice Address - Country:US
Practice Address - Phone:718-240-0614
Practice Address - Fax:718-240-0601
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084532-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY132655001Medicaid