Provider Demographics
NPI:1992584049
Name:RODRIGUEZ, MARY V (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:V
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:5605 N 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-1761
Mailing Address - Country:US
Mailing Address - Phone:602-401-1765
Mailing Address - Fax:
Practice Address - Street 1:810 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1318
Practice Address - Country:US
Practice Address - Phone:602-462-1115
Practice Address - Fax:602-462-1119
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW213701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical