Healthcare Provider Details

I. General information

NPI: 1891526117
Provider Name (Legal Business Name): GUSMARY RODRIGUEZ MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7651 GATE PKWY APT 1809
JACKSONVILLE FL
32256-4818
US

IV. Provider business mailing address

1855 WELLS RD STE 1
ORANGE PARK FL
32073-6766
US

V. Phone/Fax

Practice location:
  • Phone: 516-375-9965
  • Fax: 904-615-6919
Mailing address:
  • Phone: 904-523-1287
  • Fax: 904-615-6919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-367520
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: