Provider Demographics
NPI:1467097824
Name:RODRIGUEZ, CAMILLE DENISE (ACSW)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:DENISE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 TAYLOR BLVD STE 115
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2200
Mailing Address - Country:US
Mailing Address - Phone:925-440-6046
Mailing Address - Fax:
Practice Address - Street 1:399 TAYLOR BLVD STE 115
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2200
Practice Address - Country:US
Practice Address - Phone:925-440-6046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-08
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA916471041C0700X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician