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General NPI Number Information
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NPI Number | 1396505426
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Entity Type | Individual
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Provider Name | VICTOR RODRIGUEZ JR. LAC
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Gender | Male
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Dates
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Enumeration Date | 03/19/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 13 FAIRFIELD AVE
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-1264
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Country | US
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Telephone | 973-638-1120
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Fax | 973-638-1126
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Provider Business Mailing Address
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Address Line | 15 BEAUMONT PL
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City | NEWARK
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State | NJ
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Zip | 07104-1611
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Country | US
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Telephone | 973-934-5377
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Fax | 973-638-1120
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 37AC00450800
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License Number State | NJ
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