MEDICARE: MRS. JOSEPHINE VANESSA RODRIGUEZ PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	26NJ15044500	NJ

General Provider Information

NPI Number	:	1952165003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOSEPHINE VANESSA RODRIGUEZ PMHNP-BC

Provider Business Mailing Address
First Line	:	35 STRATFORD RD
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-1123
Country	:	US
Telephone Number	:	201-925-7633
Fax Number	:

Provider Business Practice Location Address
First Line	:	510 MOUNT PROSPECT AVE
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07104-2904
Country	:	US
Telephone Number	:	201-925-7633
Fax Number	:

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

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	12/12/2025

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