Healthcare Provider Details

I. General information

NPI: 1285111955
Provider Name (Legal Business Name): JINNETTE RODRIGUEZ PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 9445
BAYAMON PR
00960-9445
US

IV. Provider business mailing address

PO BOX 9445
BAYAMON PR
00960-9445
US

V. Phone/Fax

Practice location:
  • Phone: 939-745-5415
  • Fax:
Mailing address:
  • Phone: 939-745-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number5986
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number5986
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number5986
License Number StatePR
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number5986
License Number StatePR
# 5
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number5986
License Number StatePR
# 6
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number5986
License Number StatePR
# 7
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number5986
License Number StatePR
# 8
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number5986
License Number StatePR
# 9
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number5986
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: