Healthcare Provider Details

I. General information

NPI: 1588458129
Provider Name (Legal Business Name): NICOLE M RODRIGUEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6484 SW 25TH ST
MIAMI FL
33155-2958
US

IV. Provider business mailing address

6484 SW 25TH ST
MIAMI FL
33155-2958
US

V. Phone/Fax

Practice location:
  • Phone: 786-389-4614
  • Fax:
Mailing address:
  • Phone: 786-389-4614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: