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NPI Code Detail

MEDICARE: DAISY JENNIFER RODRIGUEZ LCSW

MEDICARE: DAISY JENNIFER RODRIGUEZ 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 Worker105922TX

General Provider Information

NPI Number : 1790326114
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAISY JENNIFER RODRIGUEZ LCSW
Provider Business Mailing Address
First Line : PO BOX 746079
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6079
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1950 EPHRIHAM AVE
Second Line :
City : FORT WORTH
State : TX
Zip : 76164-6670
Country : US
Telephone Number : 817-813-7075
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2019
Last Update Date : 09/18/2025

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