Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist |
NPI | 1104226521 |
---|---|
Provider Name | Mr. Steven Rodriguez |
First Address | Sunrise, FL 33325-6236 |
Second Address | Sunrise, FL 33325-6236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 04/09/2014 |