MEDICARE: MONICA RODRIGUES 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	101YM0800X	Mental Health Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1770813222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA RODRIGUES MSW

Provider Business Mailing Address
First Line	:	PO BOX 82819
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97282-0819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3500 NE MARTIN LUTHER KING BLVD
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-2093
Country	:	US
Telephone Number	:	503-233-5405
Fax Number	:

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

Provider Enumeration Date	:	01/06/2010
Last Update Date	:	04/12/2016

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