Healthcare Provider Details

I. General information

NPI: 1598833352
Provider Name (Legal Business Name): VIVIAN RODRIGUEZ MSW, DCSW, CAC III,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 CALLE DRESDE PUERTO NUEVO
SAN JUAN PR
00920-3731
US

IV. Provider business mailing address

469 CALLE DRESDE VILLA BORINQUEN
SAN JUAN PR
00920-3708
US

V. Phone/Fax

Practice location:
  • Phone: 787-792-0278
  • Fax: 787-792-0278
Mailing address:
  • Phone: 787-792-0278
  • Fax: 787-792-0278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2740
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: