Healthcare Provider Details

I. General information

NPI: 1477722304
Provider Name (Legal Business Name): CAMILA RODRIGUEZ MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 HAVEMEYER ST FL 3
BROOKLYN NY
11211-6277
US

IV. Provider business mailing address

217 HAVEMEYER ST FL 3
BROOKLYN NY
11211-6277
US

V. Phone/Fax

Practice location:
  • Phone: 718-963-7655
  • Fax:
Mailing address:
  • Phone: 718-963-7655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number001167
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: