Provider Demographics
NPI:1982969382
Name:RODRIGUEZ, GLADYS A (MSW)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:A
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW
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 3359
Mailing Address - Street 2:
Mailing Address - City:ARECIBO
Mailing Address - State:PR
Mailing Address - Zip Code:00613-3359
Mailing Address - Country:US
Mailing Address - Phone:787-236-9082
Mailing Address - Fax:787-878-0683
Practice Address - Street 1:49 CALLE MORELL CAMPOS
Practice Address - Street 2:
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612-4318
Practice Address - Country:US
Practice Address - Phone:787-236-9082
Practice Address - Fax:787-878-0683
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10447.104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker