MEDICARE: YVONNE MARIE RODRIGUEZ L.C.S.W.

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	1041C0700X	Clinical Social Worker	SW3022	FL
2	101YM0800X	Mental Health Counselor	SW3022	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z6527	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1821146507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE MARIE RODRIGUEZ L.C.S.W.

Provider Business Mailing Address
First Line	:	1729 W LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7518
Country	:	US
Telephone Number	:	813-404-7405
Fax Number	:	--

Provider Business Practice Location Address
First Line	:	1729 W LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7518
Country	:	US
Telephone Number	:	813-404-7405
Fax Number	:	--

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

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	08/08/2022

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