Individual
KIMBERLY IVERNE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRMA
Contact information
Practice address
52 GARDINER STREET, PATTEN, ME 04765
(207) 528-2203
Mailing address
PO BOX 226, PATTEN, ME 04765-0226
(207) 528-2203
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202450000
—
ME
Enumeration date
05/06/2009
Last updated
05/06/2009
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