Healthcare Provider Details

I. General information

NPI: 1366305146
Provider Name (Legal Business Name): LORRAINE RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9-23 AVENIDA UNIVERSIDAD INTERAMERICANA
SAN GERMAN PR
00683
US

IV. Provider business mailing address

HC 10 BOX 6582
SABANA GRANDE PR
00637-9604
US

V. Phone/Fax

Practice location:
  • Phone: 939-257-2039
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7743
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: