Provider Demographics
NPI:1346694734
Name:RODRIGUEZ, MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 80 BOX 22849
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96367-0113
Mailing Address - Country:US
Mailing Address - Phone:813-575-2276
Mailing Address - Fax:
Practice Address - Street 1:UNIT 5142 BOX MDG
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96368-5142
Practice Address - Country:US
Practice Address - Phone:813-575-2276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW105761041C0700X
FLSW142261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIX025Z-PASCOMedicare PIN
FLIX025Y-TPAMedicare PIN