MEDICARE: JESSICA RODRIGUEZ LCSW

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	SW21037	FL

General Provider Information

NPI Number	:	1144181629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA RODRIGUEZ LCSW

Provider Business Mailing Address
First Line	:	1253 HALBER AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-5802
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1253 HALBER AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-5802
Country	:	US
Telephone Number	:	321-506-4027
Fax Number	:

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

Provider Enumeration Date	:	11/24/2025
Last Update Date	:	11/24/2025

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