Healthcare Provider Details

I. General information

NPI: 1609795319
Provider Name (Legal Business Name): MARIAN NELLY RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 FORDHAM RD
ALLSTON MA
02134-3000
US

IV. Provider business mailing address

50 YORK ST
CAMBRIDGE MA
02141-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-782-6460
  • Fax: 617-782-6645
Mailing address:
  • Phone: 617-782-6460
  • Fax: 617-782-6457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: