MEDICARE: MS. SONIA RODRIGUEZ L.M.S.W.

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	104100000X	Social Worker	074197-1	NY

General Provider Information

NPI Number	:	1588968911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SONIA RODRIGUEZ L.M.S.W.

Provider Business Mailing Address
First Line	:	3213 79TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1839
Country	:	US
Telephone Number	:	718-533-1273
Fax Number	:

Provider Business Practice Location Address
First Line	:	3213 79TH ST
Second Line	:
City	:	EAST ELMHURST
State	:	NY
Zip	:	11370-1839
Country	:	US
Telephone Number	:	718-533-1273
Fax Number	:

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

Provider Enumeration Date	:	12/28/2010
Last Update Date	:	12/28/2010

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