Provider Demographics
NPI:1417400185
Name:RODRIGUEZ, WANDA
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:
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 1:8331 116TH ST
Mailing Address - Street 2:APT 1E
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-3490
Mailing Address - Country:US
Mailing Address - Phone:347-222-9265
Mailing Address - Fax:718-497-9495
Practice Address - Street 1:315 WYCKOFF AVE
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5384
Practice Address - Country:US
Practice Address - Phone:718-497-6090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health