1598520926 NPI number — BRENDA GUADALUPE HERNANDEZ RODRIGUEZ LCSW

Table of content: BRENDA GUADALUPE HERNANDEZ RODRIGUEZ LCSW (NPI 1598520926)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598520926 NPI number — BRENDA GUADALUPE HERNANDEZ RODRIGUEZ LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERNANDEZ RODRIGUEZ
Provider First Name:
BRENDA
Provider Middle Name:
GUADALUPE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HERNANDEZ RODRIGUEZ
Provider Other First Name:
BRENDA
Provider Other Middle Name:
GUADALUPE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598520926
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
311 E 175TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457-5859
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-960-7522
Provider Business Mailing Address Fax Number:
718-583-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
915 WESTCHESTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10459-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-224-9300
Provider Business Practice Location Address Fax Number:
718-764-1574
Provider Enumeration Date:
02/15/2024

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:  122532 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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