Healthcare Provider Details

I. General information

NPI: 1275332124
Provider Name (Legal Business Name): ALEX RODRIGUES PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5046 MEADE ST
DENVER CO
80221-1034
US

IV. Provider business mailing address

23 DOROTHY LN
HOLBROOK NY
11741-3515
US

V. Phone/Fax

Practice location:
  • Phone: 631-806-6117
  • Fax:
Mailing address:
  • Phone: 631-806-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY1000947
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number05606
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number0810005165
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number35SI00597300
License Number StateNJ
# 5
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY000.4805
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: