1124805163 NPI number — DENISE RODRIGUES LSW

Table of content: DENISE RODRIGUES LSW (NPI 1124805163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124805163 NPI number — DENISE RODRIGUES LSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RODRIGUES
Provider First Name:
DENISE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124805163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 MASON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE HOPATCONG
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07849-1212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-572-5480
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 KALISA WAY STE 211
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-529-7010
Provider Business Practice Location Address Fax Number:
201-652-6253
Provider Enumeration Date:
09/13/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  44SL07022000 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44SL07022000 . This is a "LICENSED SOCIAL WORKER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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