Healthcare Provider Details

I. General information

NPI: 1598676835
Provider Name (Legal Business Name): MARIO ROBERT RODRIGUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 S KNOXVILLE WAY
DENVER CO
80227-3860
US

IV. Provider business mailing address

2852 S KNOXVILLE WAY
DENVER CO
80227-3860
US

V. Phone/Fax

Practice location:
  • Phone: 720-220-4538
  • Fax:
Mailing address:
  • Phone: 720-220-4538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW.00991018
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: