Provider Demographics
NPI:1467286435
Name:RODRIGUEZ, ALICIA TATIANA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:TATIANA
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 1:538 JEFFERSON AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-1680
Mailing Address - Country:US
Mailing Address - Phone:914-575-8676
Mailing Address - Fax:
Practice Address - Street 1:2975 WESTCHESTER AVE STE 202
Practice Address - Street 2:
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2500
Practice Address - Country:US
Practice Address - Phone:914-305-5345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist