Healthcare Provider Details

I. General information

NPI: 1285596130
Provider Name (Legal Business Name): TERESA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 BAY RIDGE PKWY
BROOKLYN NY
11209-3309
US

IV. Provider business mailing address

134 VERNON AVE
BROOKLYN NY
11206-6503
US

V. Phone/Fax

Practice location:
  • Phone: 929-200-3049
  • Fax:
Mailing address:
  • Phone: 862-236-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129677-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: