Healthcare Provider Details

I. General information

NPI: 1003142233
Provider Name (Legal Business Name): JOSE ANGEL RODRIGUEZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 EAST 161ST C/O MONTEFIORE
BRONX NY
10451
US

IV. Provider business mailing address

110 W 97TH ST C/O WILLIAM F. RYAN COMMUNITY HEALTH CENTER
NEW YORK NY
10025-6450
US

V. Phone/Fax

Practice location:
  • Phone: 718-410-3561
  • Fax: 718-410-3629
Mailing address:
  • Phone: 212-749-1820
  • Fax: 212-932-8323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number081480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: