Provider Demographics
NPI:1497065510
Name:RODRIGUEZ, LISA JO (MA , LMFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JO
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MA , LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 ENCINAL CANYON RD
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-2404
Mailing Address - Country:US
Mailing Address - Phone:818-889-1353
Mailing Address - Fax:
Practice Address - Street 1:427 ENCINAL CANYON RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-2404
Practice Address - Country:US
Practice Address - Phone:818-889-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist