Healthcare Provider Details

I. General information

NPI: 1770904906
Provider Name (Legal Business Name): DESIREE RODRIGUEZ BSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 12/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

1303 KING AVE APT C
COLUMBUS OH
43212-2224
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-7837
  • Fax:
Mailing address:
  • Phone: 419-733-1416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS1200213
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: