Provider Demographics
NPI:1427340181
Name:RODRIGUEZ, ANDREA BENN (DED)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:BENN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1708
Mailing Address - Country:US
Mailing Address - Phone:917-862-5457
Mailing Address - Fax:
Practice Address - Street 1:438 STATE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1708
Practice Address - Country:US
Practice Address - Phone:917-862-5457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2015-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003437101YM0800X
NY021271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health