Provider Demographics
NPI:1902655228
Name:RODRIGUEZ, ANYSE MARIA (RBT)
Entity type:Individual
Prefix:
First Name:ANYSE
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 COUNTY ROAD 3015
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-6145
Mailing Address - Country:US
Mailing Address - Phone:832-438-9428
Mailing Address - Fax:
Practice Address - Street 1:549 COUNTY ROAD 3015
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-6145
Practice Address - Country:US
Practice Address - Phone:832-438-9428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-22-223822104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker