Healthcare Provider Details

I. General information

NPI: 1083958920
Provider Name (Legal Business Name): MELISSA RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BROADWAY
GARY IN
46408-4605
US

IV. Provider business mailing address

30 W MONROE ST STE 1200
CHICAGO IL
60603-2420
US

V. Phone/Fax

Practice location:
  • Phone: 219-237-5170
  • Fax: 219-321-1931
Mailing address:
  • Phone: 312-733-9730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33006355A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: