Healthcare Provider Details

I. General information

NPI: 1558411876
Provider Name (Legal Business Name): MIGUELINA M RODRIGUEZ PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 03/08/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SOUTH BEACH PSYCHIATRIC CENTER 777 SEAVIEW AVENUE BRIDGEVIEW 5A/B
STATEN ISLAND NY
10305
US

IV. Provider business mailing address

SOUTH BEACH PSYCHIATRIC CENTER 777 SEAVIEW AVENUE BRIDGEVIEW 5A/B
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2600
  • Fax: 718-667-2613
Mailing address:
  • Phone: 646-552-7078
  • Fax: 718-667-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number014288-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: