Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | NY | |
Y | 1041C0700X | Clinical Social Worker | 081480 | NY |
NPI | 1003142233 |
---|---|
Provider Name | Mr. Jose Angel Rodriguez |
First Address | New York, NY 10025-6450 |
Second Address | Bronx, NY 10451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2009 |
Last Update Date | 21/06/2016 |