MEDICARE: DESIREE ALEXIS 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	SW13497	FL
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1194169201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DESIREE ALEXIS RODRIGUEZ LCSW

Provider Business Mailing Address
First Line	:	552 SHADOW GLENN PL
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4649
Country	:	US
Telephone Number	:	407-362-8955
Fax Number	:

Provider Business Practice Location Address
First Line	:	552 SHADOW GLENN PL
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4649
Country	:	US
Telephone Number	:	407-362-8955
Fax Number	:

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	08/20/2023

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