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NPI Code Detail

MEDICARE: ROBERTO RODRIGUEZ SOCIAL WORK LCSW

MEDICARE:   ROBERTO  RODRIGUEZ  SOCIAL WORK 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
11041C0700XClinical Social Worker11830TX

General Provider Information

NPI Number : 1639606783
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO RODRIGUEZ SOCIAL WORK LCSW
Provider Business Mailing Address
First Line : 5011 BLANCHARD DR
Second Line :
City : DALLAS
State : TX
Zip : 75227-1414
Country : US
Telephone Number : 214-789-0726
Fax Number :
Provider Business Practice Location Address
First Line : 5011 BLANCHARD DR
Second Line :
City : DALLAS
State : TX
Zip : 75227-1414
Country : US
Telephone Number : 214-789-0726
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/19/2017
Last Update Date : 05/19/2017

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Directions to “ ROBERTO RODRIGUEZ SOCIAL WORK LCSW” Practice Location

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