Provider Demographics
NPI:1982908778
Name:RODRIGUEZ, OLGA NOEMI (MA)
Entity type:Individual
Prefix:MRS
First Name:OLGA
Middle Name:NOEMI
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 360118
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-0118
Mailing Address - Country:US
Mailing Address - Phone:787-612-5846
Mailing Address - Fax:
Practice Address - Street 1:M31 CALLE 13
Practice Address - Street 2:URB. CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2443
Practice Address - Country:US
Practice Address - Phone:787-703-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2807103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool