Healthcare Provider Details

I. General information

NPI: 1295031490
Provider Name (Legal Business Name): ELOISA NEGRON RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELOISA NEGRON RODRIGUEZ LCSW

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CANNON PL
BRONX NY
10463-4302
US

IV. Provider business mailing address

800 GRAND CONCOURSE APT 1BN
BRONX NY
10451-3029
US

V. Phone/Fax

Practice location:
  • Phone: 718-796-8100
  • Fax:
Mailing address:
  • Phone: 917-842-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP78760
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: