MEDICARE: STEPHANIE RODRIGUEZ

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	103K00000X	Behavior Analyst
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1427415439
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE RODRIGUEZ

Provider Business Mailing Address
First Line	:	6427 SW 13TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5623
Country	:	US
Telephone Number	:	786-683-7039
Fax Number	:

Provider Business Practice Location Address
First Line	:	6427 SW 13TH ST
Second Line	:
City	:	WEST MIAMI
State	:	FL
Zip	:	33144-5623
Country	:	US
Telephone Number	:	786-683-7039
Fax Number	:

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

Provider Enumeration Date	:	01/21/2016
Last Update Date	:	06/21/2016

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Directions to “ STEPHANIE RODRIGUEZ ” Practice Location

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