MEDICARE: KIMBERLEY BERNADETTE RODRIGUEZ LMFT, CAP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	4774	FL
2	106H00000X	Marriage & Family Therapist	MT2273	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013214311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEY BERNADETTE RODRIGUEZ LMFT, CAP

Provider Business Mailing Address
First Line	:	1540 MERIDIAN AVE APT 4C
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3490
Country	:	US
Telephone Number	:	305-490-4681
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 MERIDIAN AVE APT 4C
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-3490
Country	:	US
Telephone Number	:	305-490-4681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2011
Last Update Date	:	02/22/2011

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