Provider Demographics
NPI:1316748189
Name:RODRIGUEZ, KENNILY (MS)
Entity type:Individual
Prefix:
First Name:KENNILY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 TITANIA RD
Mailing Address - Street 2:
Mailing Address - City:TOBYHANNA
Mailing Address - State:PA
Mailing Address - Zip Code:18466-8266
Mailing Address - Country:US
Mailing Address - Phone:347-254-1788
Mailing Address - Fax:347-254-1788
Practice Address - Street 1:711 32ND ST
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2418
Practice Address - Country:US
Practice Address - Phone:201-865-7450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor