Provider Demographics
NPI:1821375213
Name:RODRIGUEZ, LILLIAM (PHD)
Entity type:Individual
Prefix:
First Name:LILLIAM
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HARRIS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-2031
Mailing Address - Country:US
Mailing Address - Phone:954-740-9662
Mailing Address - Fax:
Practice Address - Street 1:701 SW 27TH AVE
Practice Address - Street 2:SUITE G20
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:305-643-7800
Practice Address - Fax:305-643-1345
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022499103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical