MEDICARE: SOPHIA RODRIGUEZ MA, LAC, NCC

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	37AC00883200	NJ

General Provider Information

NPI Number	:	1770434532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA RODRIGUEZ MA, LAC, NCC

Provider Business Mailing Address
First Line	:	8901 KENNEDY BLVD STE 4W
Second Line	:
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-5345
Country	:	US
Telephone Number	:	201-757-3800
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 38TH ST STE 222
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-4848
Country	:	US
Telephone Number	:	201-757-3800
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ SOPHIA RODRIGUEZ MA, LAC, NCC” Practice Location

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