Healthcare Provider Details

I. General information

NPI: 1134543184
Provider Name (Legal Business Name): REBECCA RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA VEGA

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 07/22/2021
Certification Date: 07/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FAS PSYCH, LCC 8687 E. VIA DE VENTURA, #310
SCOTTSDALE AZ
85258
US

IV. Provider business mailing address

FAS PSYCH, LCC 8687 E. VIA DE VENTURA, #310
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 508-559-1567
  • Fax:
Mailing address:
  • Phone: 508-559-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number122049
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number219312
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number219312
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: