Healthcare Provider Details

I. General information

NPI: 1417766809
Provider Name (Legal Business Name): HECTOR RODRIGUEZ MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 ROUTE 516
MATAWAN NJ
07747-7031
US

IV. Provider business mailing address

4122 ROUTE 516
MATAWAN NJ
07747-7031
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-4500
  • Fax: 732-679-4549
Mailing address:
  • Phone: 732-679-4500
  • Fax: 732-679-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC04704500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: