Healthcare Provider Details

I. General information

NPI: 1386483865
Provider Name (Legal Business Name): LAHYZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MASSACHUSETTS AVE CENTRAL HOUSE
CAMBRIDGE MA
01702
US

IV. Provider business mailing address

820 MASSACHUSETTS AVE CENTRAL HOUSE
CAMBRIDGE MA
01702
US

V. Phone/Fax

Practice location:
  • Phone: 774-707-0141
  • Fax:
Mailing address:
  • Phone: 774-707-0141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number5894
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number1234
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: