Healthcare Provider Details

I. General information

NPI: 1497692883
Provider Name (Legal Business Name): EMILY RODRIGUES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 DUDLEY ST
ROXBURY MA
02119-2732
US

IV. Provider business mailing address

504 DUDLEY ST
ROXBURY MA
02119-2732
US

V. Phone/Fax

Practice location:
  • Phone: 857-656-1971
  • Fax:
Mailing address:
  • Phone: 857-656-1971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: