Provider Demographics
NPI:1568153344
Name:RODRIGUEZ, MARLAINA SHALISE (ACSW)
Entity Type:Individual
Prefix:
First Name:MARLAINA
Middle Name:SHALISE
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 1:4059 INNOVATOR DR UNIT 5101
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7917
Mailing Address - Country:US
Mailing Address - Phone:818-585-8168
Mailing Address - Fax:
Practice Address - Street 1:600 A ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3649
Practice Address - Country:US
Practice Address - Phone:530-204-9467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113912104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker