MEDICARE: STELLA DIMARIS CRUZ RODRIGUEZ 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	103T00000X	Psychologist	PSY004432	GA

General Provider Information

NPI Number	:	1578162970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA DIMARIS CRUZ RODRIGUEZ PSYD

Provider Business Mailing Address
First Line	:	3316-A S COBB DRIVE PMB 127
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080
Country	:	US
Telephone Number	:	470-568-3611
Fax Number	:	470-804-0014

Provider Business Practice Location Address
First Line	:	3316-A S COBB DRIVE PMB 127
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080
Country	:	US
Telephone Number	:	470-568-3611
Fax Number	:	470-804-0014

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

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	04/21/2026

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