Provider Demographics
NPI:1962725622
Name:RODRIGUEZ, GILBERTO (MSW, PGSW)
Entity type:Individual
Prefix:
First Name:GILBERTO
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:MSW, PGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15785 MEDICAL ARTS DR
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1447
Mailing Address - Country:US
Mailing Address - Phone:985-543-4080
Mailing Address - Fax:985-543-4090
Practice Address - Street 1:15785 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1447
Practice Address - Country:US
Practice Address - Phone:985-543-4080
Practice Address - Fax:985-543-4090
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10688104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA11166Medicaid