MEDICARE: NANCY RODRIGUEZ BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1225741234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY RODRIGUEZ BCBA

Provider Business Mailing Address
First Line	:	200 GREENE ST
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07311-1401
Country	:	US
Telephone Number	:	347-981-4870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1114 GERARD AVE APT 26
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-8851
Country	:	US
Telephone Number	:	347-981-4870
Fax Number	:

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

Provider Enumeration Date	:	01/04/2023
Last Update Date	:	08/03/2023

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