MEDICARE: TABITHA STAR RODRIGUEZ LMSW

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	104100000X	Social Worker	118207	NY
2	1041C0700X	Clinical Social Worker	118207	NY

General Provider Information

NPI Number	:	1154198414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TABITHA STAR RODRIGUEZ LMSW

Provider Business Mailing Address
First Line	:	8218 AVENUE J
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3669
Country	:	US
Telephone Number	:	929-385-4773
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 JUMEL PL
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-4316
Country	:	US
Telephone Number	:	929-385-4773
Fax Number	:

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

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	02/03/2026

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