Healthcare Provider Details

I. General information

NPI: 1376270975
Provider Name (Legal Business Name): DANIELLE ASHLEY RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 JERICHO TPKE STE 103
JERICHO NY
11753-1317
US

IV. Provider business mailing address

668 BUSHWICK AVE APT 309
BROOKLYN NY
11221-8315
US

V. Phone/Fax

Practice location:
  • Phone: 516-399-5373
  • Fax:
Mailing address:
  • Phone: 646-373-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: