Healthcare Provider Details

I. General information

NPI: 1063345130
Provider Name (Legal Business Name): DAMARIS RODRIGUEZ MSED, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 APPLEGATE RD STE 100
STROUDSBURG PA
18360-6502
US

IV. Provider business mailing address

205 APPLEGATE RD STE 100
STROUDSBURG PA
18360-6502
US

V. Phone/Fax

Practice location:
  • Phone: 570-688-5883
  • Fax:
Mailing address:
  • Phone: 570-688-5883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020440
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: