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General NPI Number Information
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NPI Number | 1700157526
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Entity Type | Individual
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Provider Name | RAISA AIMME RODRIGUEZ PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2012
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Last Update Date | 01/25/2012
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Provider Practice Location Address
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Address Line | AVE. SANCHEZ CASTANO 2DA EXT VILLA CAROLINA CALLE 18 BLQ. 22 # 2
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City | CAROLINA
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State | PR
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Zip | 00985
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Country | US
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Telephone | 787-637-0375
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Fax | 787-752-8466
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Provider Business Mailing Address
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Address Line | COND JARDIN SERENO APT 1002
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City | CAROLINA
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State | PR
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Zip | 00983
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Country | US
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Telephone | 787-637-0375
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Fax | 787-752-8466
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4189
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 4189
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License Number State | PR
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 4189
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License Number State | PR
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