=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285056572
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATHERINE RODRIGUEZ LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2014
-----------------------------------------------------
Last Update Date | 09/01/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2090 ADAM CLAYTON POWELL JR BLVD 7TH FLOOR
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-4990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-306-2279
-----------------------------------------------------
Fax | 212-660-1327
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 590 AVENUE OF THE AMERICAS ATTN: CREDENTIALING
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10011-2022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-306-2279
-----------------------------------------------------
Fax | 212-660-1327
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 095248
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------