=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255641866
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPHINE LAQUIS RODRIGUEZ MS, NCC, LMFT, LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2010
-----------------------------------------------------
Last Update Date | 11/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5412 E LEITNER DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-856-4588
-----------------------------------------------------
Fax | 954-341-4129
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5412 E LEITNER DR
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33067-2045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-856-4588
-----------------------------------------------------
Fax | 954-341-4129
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MH11367
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2712
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------