Healthcare Provider Details

I. General information

NPI: 1609172790
Provider Name (Legal Business Name): GRISEL RODRIGUEZ CONDE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA PUERTA DEL SOL CALLE MIGUEL OTERO 202 SUITE 101
MANATI PR
00674
US

IV. Provider business mailing address

PO BOX 3
BARCELONETA PR
00617-0003
US

V. Phone/Fax

Practice location:
  • Phone: 787-854-0001
  • Fax: 787-854-0030
Mailing address:
  • Phone: 787-614-8968
  • Fax: 787-854-0030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7677
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: