=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598417636
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA RODRIGUEZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2022
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 350 SUNRISE HWY
-----------------------------------------------------
City | ROCKVILLE CTR
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11570-4908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-763-4764
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63 NEW YORK AVE
-----------------------------------------------------
City | CONGERS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10920-2515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
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 | 116799
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------