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General NPI Number Information
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NPI Number | 1093160558
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Entity Type | Individual
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Provider Name | LUCELY D RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 05/03/2016
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 6 UTTER ST
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City | NORTH PROVIDENCE
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State | RI
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Zip | 02904-5324
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Country | US
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Telephone | 401-376-3097
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Fax |
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Provider Business Mailing Address
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Address Line | 555 N MAIN ST # 1171
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City | PROVIDENCE
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State | RI
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Zip | 02904-5722
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Country | US
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Telephone | 401-376-3093
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW03495
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License Number State | RI
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