MEDICARE: ELIZABETH MARY RODRIGUEZ

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	101YM0800X	Mental Health Counselor	D008113-1	NY

General Provider Information

NPI Number	:	1336656883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY RODRIGUEZ

Provider Business Mailing Address
First Line	:	19 LAGUNA RD
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-5665
Country	:	US
Telephone Number	:	914-552-5543
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 LAGUNA RD
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-5665
Country	:	US
Telephone Number	:	914-552-5543
Fax Number	:

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

Provider Enumeration Date	:	01/05/2018
Last Update Date	:	02/05/2026

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