Provider Demographics
NPI:1033310867
Name:RODRIGUEZ-COSTELLO, IRIS GISEL (LMFT)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:GISEL
Last Name:RODRIGUEZ-COSTELLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:IRIS
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:2000 ALAMEDA DE LAS PULGAS STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1293
Mailing Address - Country:US
Mailing Address - Phone:650-372-3203
Mailing Address - Fax:650-341-0674
Practice Address - Street 1:2000 ALAMEDA DE LAS PULGAS STE 200
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1293
Practice Address - Country:US
Practice Address - Phone:650-372-3203
Practice Address - Fax:650-341-7389
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist