Healthcare Provider Details

I. General information

NPI: 1215232921
Provider Name (Legal Business Name): BRENDA CHERYL RODRIGUEZ SOCIAL WORKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2011
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 GRAND STREET 2ND FLOOR
NEW YORK NY
10002
US

IV. Provider business mailing address

465 GRAND STREET 2ND FLOOR HAND IN HAND DEVELOPMENT INC.
NEW YORK NY
10002
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-1999
  • Fax: 212-420-1910
Mailing address:
  • Phone: 212-420-1999
  • Fax: 212-420-1910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number070675-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: