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General NPI Number Information
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NPI Number | 1033644000
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Entity Type | Individual
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Provider Name | SUSAN M. RODRIGUEZ M.S., LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 8100 NW 53RD ST APT 163
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City | DORAL
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State | FL
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Zip | 33166-4796
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Country | US
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Telephone | 786-464-9059
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Fax | 786-464-9059
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Provider Business Mailing Address
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Address Line | 8100 NW 53RD ST APT 163
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City | DORAL
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State | FL
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Zip | 33166-4796
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Country | US
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Telephone | 786-464-9059
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Fax | 786-464-9059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH9114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E2734
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5186
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | S16573
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License Number State | OH
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