Provider Demographics
NPI:1376748046
Name:RHOADS-BRIDGHAM, KARIN M (LCSW)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:M
Last Name:RHOADS-BRIDGHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31557 CULBERTSON LN
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-7901
Mailing Address - Country:US
Mailing Address - Phone:951-699-3509
Mailing Address - Fax:
Practice Address - Street 1:780 SHADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-7986
Practice Address - Country:US
Practice Address - Phone:760-599-2350
Practice Address - Fax:760-599-2399
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALV111391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical