MEDICARE: ALISON C RODRIGUEZ

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1942056718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON C RODRIGUEZ

Provider Business Mailing Address
First Line	:	3613 BRANHUM RD
Second Line	:
City	:	EDGEWATER
State	:	MD
Zip	:	21037-3532
Country	:	US
Telephone Number	:	443-878-2458
Fax Number	:

Provider Business Practice Location Address
First Line	:	2076 S INDEPENDENCE BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23453-4779
Country	:	US
Telephone Number	:	757-622-7272
Fax Number	:

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

Provider Enumeration Date	:	04/24/2024
Last Update Date	:	06/13/2024

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Directions to “ ALISON C RODRIGUEZ ” Practice Location

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