Provider Demographics
NPI:1043567746
Name:RODRIGUEZ, BRANDY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRANDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 LIBERTY PARK DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-1379
Mailing Address - Country:US
Mailing Address - Phone:661-664-0158
Mailing Address - Fax:
Practice Address - Street 1:8625 LIBERTY PARK DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-1379
Practice Address - Country:US
Practice Address - Phone:661-664-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical