MEDICARE: YVETTE RODRIGUEZ LMSW

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	LMSW-15429	AZ

General Provider Information

NPI Number	:	1942718861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVETTE RODRIGUEZ LMSW

Provider Business Mailing Address
First Line	:	5469 S GAINSBOROUGH RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85746-3909
Country	:	US
Telephone Number	:	520-358-1752
Fax Number	:

Provider Business Practice Location Address
First Line	:	4501 E 5TH ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-7015
Country	:	US
Telephone Number	:	520-546-0122
Fax Number	:

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

Provider Enumeration Date	:	01/12/2018
Last Update Date	:	01/12/2018

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