Provider Demographics
NPI:1043436074
Name:RODRIGUEZ, MARIANELA (MA)
Entity type:Individual
Prefix:MRS
First Name:MARIANELA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUITE 164
Mailing Address - Street 2:PO BOX 10000
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-205-4104
Mailing Address - Fax:
Practice Address - Street 1:AVE. JOSE DE DIEGO
Practice Address - Street 2:393 OESTE
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00737-2770
Practice Address - Country:US
Practice Address - Phone:787-738-2222
Practice Address - Fax:787-738-2149
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR74561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical