Healthcare Provider Details

I. General information

NPI: 1639124753
Provider Name (Legal Business Name): GERALD J RODRIGUEZ LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 S CEDAR CREST BLVD STE 2200
ALLENTOWN PA
18103-6268
US

IV. Provider business mailing address

1605 N CEDAR CREST BLVD STE 411
ALLENTOWN PA
18104-2323
US

V. Phone/Fax

Practice location:
  • Phone: 610-402-2500
  • Fax: 610-402-2506
Mailing address:
  • Phone: 610-969-1914
  • Fax: 610-969-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW006715L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: