Healthcare Provider Details

I. General information

NPI: 1841674322
Provider Name (Legal Business Name): GLADYS M RODRIGUEZ PSY.D., LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20098 ASHBROOK PL STE 255
ASHBURN VA
20147-3394
US

IV. Provider business mailing address

9202 CENTER OAK CT
MECHANICSVILLE VA
23116-2744
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810007686
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number37088
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: