Provider Demographics
NPI:1588130017
Name:RODRIGUES, EDWARD III
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:RODRIGUES
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10243 PRINCE PL APT 305
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1169
Mailing Address - Country:US
Mailing Address - Phone:301-275-4208
Mailing Address - Fax:
Practice Address - Street 1:5900 PRINCESS GARDEN PKWY STE 670
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2957
Practice Address - Country:US
Practice Address - Phone:301-851-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21598104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker