Individual
CARLOS RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CASAC-T
Contact information
Practice address
155 INDIAN HEAD RD, COMMACK, NY 11725-2212
(631) 543-6200
Mailing address
99 JAMAICA AVE, MEDFORD, NY 11763-3503
(631) 543-6200
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
26042
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26042
OASAS CERTIFICATE
NY
Enumeration date
01/21/2014
Last updated
01/21/2014
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