Provider Demographics
NPI:1386250579
Name:RODRIGUEZ, JODI MANCINI (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:MANCINI
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANN
Other - Last Name:MANCINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 341
Mailing Address - Street 2:
Mailing Address - City:HOLDER
Mailing Address - State:FL
Mailing Address - Zip Code:34445-0341
Mailing Address - Country:US
Mailing Address - Phone:352-423-0542
Mailing Address - Fax:
Practice Address - Street 1:6212 W CORPORATE OAKS DR
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-2694
Practice Address - Country:US
Practice Address - Phone:352-423-0542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW160441041C0700X
171M00000X
FLSW217261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator