Provider Demographics
NPI:1063686020
Name:RODRIGUEZ, RICHARD A (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
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:PO BOX 319
Mailing Address - Street 2:
Mailing Address - City:MAUNALOA
Mailing Address - State:HI
Mailing Address - Zip Code:96770-0319
Mailing Address - Country:US
Mailing Address - Phone:808-336-0960
Mailing Address - Fax:
Practice Address - Street 1:1787 WILI PA LOOP
Practice Address - Street 2:SUITE 7
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1280
Practice Address - Country:US
Practice Address - Phone:808-336-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-21
Last Update Date:2008-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical