MEDICARE: AMY MARIA RODRIGUES

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	067887	NY

General Provider Information

NPI Number	:	1346618964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MARIA RODRIGUES

Provider Business Mailing Address
First Line	:	71-40 112TH STREET
Second Line	:	611
City	:	FOREST HILL
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	646-256-9108
Fax Number	:

Provider Business Practice Location Address
First Line	:	7140 112TH ST
Second Line	:	611
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4658
Country	:	US
Telephone Number	:	646-256-9108
Fax Number	:

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

Provider Enumeration Date	:	09/14/2015
Last Update Date	:	09/14/2015

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