Provider Information for 1740712827
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STEPHANIE MARIE RODRIGUEZ LICSW
Other Names:Former Name:STEPHANIE M ROACH LICSWSex: Female
NPI: 1740712827
Last Updated: 2022-10-12
Certification Date: 2022-10-12
Certification Date: 2022-10-12
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1740712827 | ||||||||
| Enumeration Date | 2017-03-29 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 160 ALLEN STREET MEDICAL STAFF SERVICES RUTLAND, VT 05701 United States Phone: 802-747-3639 | Fax:802-747-6207 | ||||||||
| Primary Practice Address | 160 ALLEN ST RUTLAND, VT 05701-4560 United States Phone: 802-775-7111 | Fax: | ||||||||
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