Healthcare Provider Details

I. General information

NPI: 1942784434
Provider Name (Legal Business Name): SYLVETTE MARIE RODRIGUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 09/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM 7.5 BARRIO RIO ARRIBA SALIENTE
MANATI PR
00674
US

IV. Provider business mailing address

CALLE 15 BUZON 105 BARRIO CARMELITA
VEGA BAJA PR
00693
US

V. Phone/Fax

Practice location:
  • Phone: 787-884-5700
  • Fax: 787-884-5704
Mailing address:
  • Phone: 787-566-2855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6663
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4117
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: