Individual
JESSICA RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
BLDG #28 NM 571, EL RITO, NM 87530
(575) 581-4728
Mailing address
1305 SANTA CLARA DR, ESPANOLA, NM 87532-3226
(505) 747-7747
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C-09492
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
E7606
—
NM
Enumeration date
08/18/2010
Last updated
12/05/2016
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