MEDICARE: JAMIE MELISSA RODRIGUEZ LSW

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	1041C0700X	Clinical Social Worker	LCSW-5357	HI

General Provider Information

NPI Number	:	1053193797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE MELISSA RODRIGUEZ LSW

Provider Business Mailing Address
First Line	:	1100 WARD AVE STE 840
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1610
Country	:	US
Telephone Number	:	808-522-4521
Fax Number	:	808-522-3526

Provider Business Practice Location Address
First Line	:	1100 WARD AVE STE 840
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96814-1610
Country	:	US
Telephone Number	:	808-522-4521
Fax Number	:	808-522-3526

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

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	04/15/2026

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