MEDICARE: ALEX RODRIGUES PSYD

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
1	103TF0200X	Forensic Psychologist	PSY1000947	DC
2	103TF0200X	Forensic Psychologist	05606	MD
3	103TF0200X	Forensic Psychologist	0810005165	VA
4	103TF0200X	Forensic Psychologist	35SI00597300	NJ
5	103TF0200X	Forensic Psychologist	PSY000.4805	CO

General Provider Information

NPI Number	:	1275332124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX RODRIGUES PSYD

Provider Business Mailing Address
First Line	:	23 DOROTHY LN
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-3515
Country	:	US
Telephone Number	:	631-806-6117
Fax Number	:

Provider Business Practice Location Address
First Line	:	5046 MEADE ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80221-1034
Country	:	US
Telephone Number	:	631-806-6117
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2025
Last Update Date	:	03/12/2025

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