Healthcare Provider Details

I. General information

NPI: 1770418865
Provider Name (Legal Business Name): MR. GEORGE TYRESE RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 LOWER WESTFIELD RD STE 202
HOLYOKE MA
01040-2744
US

IV. Provider business mailing address

167 FREEMAN TER
SPRINGFIELD MA
01104-2559
US

V. Phone/Fax

Practice location:
  • Phone: 413-294-3368
  • Fax: 413-294-3449
Mailing address:
  • Phone:
  • Fax:

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: