Provider Demographics
NPI:1851902217
Name:RODRIGUEZ NOVO, ADAISIS
Entity type:Individual
Prefix:
First Name:ADAISIS
Middle Name:
Last Name:RODRIGUEZ NOVO
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 1:6711 STONECREEK ST
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3408
Mailing Address - Country:US
Mailing Address - Phone:561-805-0091
Mailing Address - Fax:
Practice Address - Street 1:2151 45TH ST STE 202
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2009
Practice Address - Country:US
Practice Address - Phone:561-823-8250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst