Provider Demographics
NPI:1477947463
Name:RODRIGUEZ, REBEKAH ANNMARIE (MASTERS OF SCIENCE)
Entity Type:Individual
Prefix:MS
First Name:REBEKAH
Middle Name:ANNMARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MASTERS OF SCIENCE
Other - Prefix:MS
Other - First Name:BEKAH
Other - Middle Name:ANNMARIE
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:3433 W SHAW AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-3229
Mailing Address - Country:US
Mailing Address - Phone:559-513-9371
Mailing Address - Fax:
Practice Address - Street 1:3433 W SHAW AVE STE 102
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3229
Practice Address - Country:US
Practice Address - Phone:559-513-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical