1720417538 NPI number — MARILYN DOMENECH-RODRIGUEZ LMHC

Table of content: MARILYN DOMENECH-RODRIGUEZ LMHC (NPI 1720417538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720417538 NPI number — MARILYN DOMENECH-RODRIGUEZ LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOMENECH-RODRIGUEZ
Provider First Name:
MARILYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHC
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:
1720417538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
137 AUTUMN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POUGHKEEPSIE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12603-5686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-589-1300
Provider Business Mailing Address Fax Number:
845-463-3891

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1285 ROUTE 9
Provider Second Line Business Practice Location Address:
SUITE 7B
Provider Business Practice Location Address City Name:
WAPPINGERS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12590-4993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-632-2939
Provider Business Practice Location Address Fax Number:
845-632-2940
Provider Enumeration Date:
11/02/2013

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: 101YM0800X , with the licence number:  001301 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X , with the licence number: 261901031 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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