Healthcare Provider Details

I. General information

NPI: 1669707600
Provider Name (Legal Business Name): OKAIRY MICAELA RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2009
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 AVENUE 64
PASADENA CA
91105
US

IV. Provider business mailing address

940 AVENUE 64
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-2274
  • Fax: 323-254-9087
Mailing address:
  • Phone: 323-254-2274
  • Fax: 323-254-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW62675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: