MEDICARE: IVELISSE RODRIGUEZ MSW

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	17411	PR

General Provider Information

NPI Number	:	1235097460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVELISSE RODRIGUEZ MSW

Provider Business Mailing Address
First Line	:	PO BOX 9809
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-9809
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	431 AVE HOSTOS
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00918-3014
Country	:	US
Telephone Number	:	787-704-0705
Fax Number	:

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

Provider Enumeration Date	:	01/15/2026
Last Update Date	:	01/15/2026

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