Healthcare Provider Details

I. General information

NPI: 1285794404
Provider Name (Legal Business Name): DANIEL RODRIGUEZ MENTAL HEALTH WORKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 E 188TH ST 4TH FL.
BRONX NY
10458-5302
US

IV. Provider business mailing address

2350 CROTONA AVE #3
BRONX NY
10458-8570
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-0483
  • Fax: 718-933-8208
Mailing address:
  • Phone: 718-367-5380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: