Healthcare Provider Details

I. General information

NPI: 1477485209
Provider Name (Legal Business Name): LILIAN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 STARR ST
BROOKLYN NY
11221-2705
US

IV. Provider business mailing address

35 STARR ST
BROOKLYN NY
11221-2705
US

V. Phone/Fax

Practice location:
  • Phone: 718-418-6389
  • Fax:
Mailing address:
  • Phone: 718-418-6389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number034374
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: