Healthcare Provider Details

I. General information

NPI: 1013260314
Provider Name (Legal Business Name): MINELIA RODRIGUEZ-ORTIZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MINELIA RODRIGUEZ

II. Dates (important events)

Enumeration Date: 10/24/2012
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOSTON MEDICAL CENTER PLACE
BOSTON MA
02118
US

IV. Provider business mailing address

801 ALBANY ST FL G
BOSTON MA
02119
US

V. Phone/Fax

Practice location:
  • Phone: 617-414-5245
  • Fax: 617-414-5520
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12140
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: