Provider Demographics
NPI:1679264840
Name:RODRIGUEZ VILLASENOR, LIZETH (ASW)
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:RODRIGUEZ VILLASENOR
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 11TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-2004
Mailing Address - Country:US
Mailing Address - Phone:323-694-8006
Mailing Address - Fax:
Practice Address - Street 1:2021 MAIN ST
Practice Address - Street 2:
Practice Address - City:OAKLEY
Practice Address - State:CA
Practice Address - Zip Code:94561-3302
Practice Address - Country:US
Practice Address - Phone:925-363-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1110701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical