Individual provider Active NPI

Raysa Rodriguez, LCSW

  • Clinical Social Worker
  • Fort Myers, FL
National Provider Identifier
1407682701
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
23561 Issued in FL
Practice address
12791 World Plaza LN BLDG 89
Fort Myers, FL 33907-3989
Phone
(239) 829-5494
NPI assigned
Sep 12, 2024
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193400000X SINGLE SPECIALTY GROUP 1041C0700X 23561 FL Primary

Addresses

Primary practice location

12791 World Plaza LN BLDG 89
Fort Myers, FL 33907-3989

Mailing address

12791 World Plaza LN BLDG 89
Fort Myers, FL 33907-3989
Phone (239) 829-5494

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241015001289 FL Practitioner - Clinical Social Worker 0840722989 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fort Myers Psychology PAGroup PAC ID 6204936305, 9 clinicians

Practice addresses (Care Compare)

12791 World Plaza LN
BLDG 89
Fort Myers, FL 33907-3989
Phone (239) 829-5494

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
23561FLMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Fort Myers Psychology, PA Single Specialty CurrentSince Jul 25, 2024 Accepting new patients

Locations

15950 McGregor Blvd
Fort Myers, FL 33908
Phone (239) 454-1277

10500 Cypress Cove Dr
Fort Myers, FL 33908
Phone (239) 214-2525

12791 World Plaza Ln
Bldg 89
Fort Myers, FL 33907
Phone (239) 247-1756

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1726099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1407682701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12791 WORLD PLAZA LN BLDG 89",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073989",
            "telephone_number": "239-829-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12791 WORLD PLAZA LN BLDG 89",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073989",
            "telephone_number": "239-829-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "RAYSA",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-12",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "23561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.