Healthcare Provider Details

I. General information

NPI: 1346113032
Provider Name (Legal Business Name): RACHEL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 OCEAN AVE STE 206
BROOKLYN NY
11229-4585
US

IV. Provider business mailing address

30 PARK AVE APT 6O
MOUNT VERNON NY
10550-2156
US

V. Phone/Fax

Practice location:
  • Phone: 917-355-7811
  • Fax:
Mailing address:
  • Phone: 917-355-7811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: