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NPI Code Detail

MEDICARE: JACQUELINE RODRIGUEZ LCSW

MEDICARE: JACQUELINE RODRIGUEZ LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker007853CT
21041C0700XClinical Social Worker0904009029VA

General Provider Information

NPI Number : 1063784320
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE RODRIGUEZ LCSW
Provider Business Mailing Address
First Line : 4379 RIDGEWOOD CENTER DR
Second Line : SUITE 4013
City : WOODBRIDGE
State : VA
Zip : 22192-8322
Country : US
Telephone Number : 703-680-7950
Fax Number : 703-680-7953
Provider Business Practice Location Address
First Line : 4379 RIDGEWOOD CENTER DR
Second Line : SUITE 4013
City : WOODBRIDGE
State : VA
Zip : 22192-8322
Country : US
Telephone Number : 703-680-7950
Fax Number : 703-680-7953
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2012
Last Update Date : 03/30/2016

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Directions to “ JACQUELINE RODRIGUEZ LCSW” Practice Location

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