Provider Demographics
NPI:1871163410
Name:DUERR-RODRIGUEZ, SALLY
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DUERR-RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 NE 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2923
Mailing Address - Country:US
Mailing Address - Phone:305-205-2321
Mailing Address - Fax:
Practice Address - Street 1:9406 NE 9TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2923
Practice Address - Country:US
Practice Address - Phone:305-205-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19339101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health