Healthcare Provider Details

I. General information

NPI: 1598417636
Provider Name (Legal Business Name): AMANDA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 SUNRISE HWY
ROCKVILLE CTR NY
11570-4908
US

IV. Provider business mailing address

63 NEW YORK AVE
CONGERS NY
10920-2515
US

V. Phone/Fax

Practice location:
  • Phone: 516-763-4764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number116799
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: