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General NPI Number Information
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NPI Number | 1083015507
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Entity Type | Individual
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Provider Name | IVETTE RODRIGUEZ-SANTANA LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 1103 CANNON RD
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City | SILVER SPRING
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State | MD
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Zip | 20904-3143
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Country | US
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Telephone | 301-910-3136
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Fax |
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Provider Business Mailing Address
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Address Line | 1103 CANNON RD
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City | SILVER SPRING
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State | MD
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Zip | 20904-3143
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Country | US
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Telephone | 301-910-3136
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Fax |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 20234
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License Number State | MD
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