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General NPI Number Information
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NPI Number | 1669293734
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Entity Type | Individual
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Provider Name | KIMBERLY RODRIGUEZ LSW
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Gender | Female
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Dates
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Enumeration Date | 10/22/2024
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 777 BLOOMFIELD AVE
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City | CLIFTON
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State | NJ
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Zip | 07012-1242
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Country | US
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Telephone | 973-594-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 290 LIBERTY ST
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City | LITTLE FERRY
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State | NJ
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Zip | 07643-1303
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Country | US
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Telephone | 201-314-9063
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SL07181900
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License Number State | NJ
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