Healthcare Provider Details

I. General information

NPI: 1285083691
Provider Name (Legal Business Name): MILDRED RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MILDRED GONZALEZ

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 12/23/2022
Certification Date: 12/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

717 PONCE DE LEON BLVD STE 307
CORAL GABLES FL
33134-2070
US

IV. Provider business mailing address

5803 NW 151ST ST STE 200B
MIAMI LAKES FL
33014-2473
US

V. Phone/Fax

Practice location:
  • Phone: 305-952-3247
  • Fax: 305-952-3248
Mailing address:
  • Phone: 646-374-6451
  • Fax: 305-529-9119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number075601
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: