MEDICARE: DEBORAH RODRIGUEZ MED, LPC

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	101YP2500X	Professional Counselor	PC005105	PA

General Provider Information

NPI Number	:	1811130842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH RODRIGUEZ MED, LPC

Provider Business Mailing Address
First Line	:	4122 DUCKHORN DR
Second Line	:
City	:	MOON TOWNSHIP
State	:	PA
Zip	:	15108-9474
Country	:	US
Telephone Number	:	412-375-7817
Fax Number	:

Provider Business Practice Location Address
First Line	:	969 GREENTREE RD
Second Line	:	5433 WALNUT ST., STE. 3, ZIP CODE: 15232
City	:	PITTSBURGH
State	:	PA
Zip	:	15220-3303
Country	:	US
Telephone Number	:	412-921-3908
Fax Number	:

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

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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