Healthcare Provider Details

I. General information

NPI: 1457228124
Provider Name (Legal Business Name): VALERIE RODRIGUEZ LSCW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 ROLLING OAKS RD
SAINT AUGUSTINE FL
32086-5409
US

IV. Provider business mailing address

231 ROLLING OAKS RD
SAINT AUGUSTINE FL
32086-5409
US

V. Phone/Fax

Practice location:
  • Phone: 727-916-0800
  • Fax:
Mailing address:
  • Phone: 727-916-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW12088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: