Healthcare Provider Details

I. General information

NPI: 1346735339
Provider Name (Legal Business Name): JANET MICHELLE RODRIGUEZ MORALES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2857 LINDEN BLVD
BROOKLYN NY
11208-5126
US

IV. Provider business mailing address

315 W BROADWAY APT BW
LONG BEACH NY
11561-3909
US

V. Phone/Fax

Practice location:
  • Phone: 718-235-3100
  • Fax:
Mailing address:
  • Phone: 646-519-1192
  • 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: