Provider Demographics
NPI:1255471637
Name:RODRIGUEZ, MARIBEL (PRE-LICENCED MSW)
Entity Type:Individual
Prefix:MISS
First Name:MARIBEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:PRE-LICENCED MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27070 E. BASELINE ST. APT. 405
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346
Mailing Address - Country:US
Mailing Address - Phone:909-863-0246
Mailing Address - Fax:909-421-9219
Practice Address - Street 1:850 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5230
Practice Address - Country:US
Practice Address - Phone:909-421-9321
Practice Address - Fax:909-421-9219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 212561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical