Healthcare Provider Details

I. General information

NPI: 1124805163
Provider Name (Legal Business Name): DENISE RODRIGUES LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KALISA WAY STE 211
PARAMUS NJ
07652-3538
US

IV. Provider business mailing address

41 MASON ST
LAKE HOPATCONG NJ
07849-1212
US

V. Phone/Fax

Practice location:
  • Phone: 914-529-7010
  • Fax: 201-652-6253
Mailing address:
  • Phone: 201-572-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07022000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier44SL07022000
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerLICENSED SOCIAL WORKER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: