Provider Demographics
NPI:1821422577
Name:RODRIGUES, ALISON K (MFT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:K
Last Name:RODRIGUES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 29TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-4903
Mailing Address - Country:US
Mailing Address - Phone:831-320-0233
Mailing Address - Fax:
Practice Address - Street 1:1670 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2510
Practice Address - Country:US
Practice Address - Phone:650-349-7969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76242251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health