Provider Demographics
NPI:1861577819
Name:RODRIGUEZ, ADRIAN (LCSW60626)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW60626
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 ESPLANADE WAY
Mailing Address - Street 2:N/A
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1011
Mailing Address - Country:US
Mailing Address - Phone:530-671-0943
Mailing Address - Fax:530-671-0943
Practice Address - Street 1:1965 LIVE OAK BLVD
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-8850
Practice Address - Country:US
Practice Address - Phone:530-822-7200
Practice Address - Fax:530-822-7108
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW606261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10018Medicaid