Provider Demographics
NPI:1396089637
Name:RODRIGUEZ, LILLIAM (MSW)
Entity type:Individual
Prefix:MS
First Name:LILLIAM
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A144 CALLE MAJAGUA
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949-4406
Mailing Address - Country:US
Mailing Address - Phone:787-407-0249
Mailing Address - Fax:
Practice Address - Street 1:A144 CALLE MAJAGUA
Practice Address - Street 2:
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949-4406
Practice Address - Country:US
Practice Address - Phone:787-407-0249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR63761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical