Provider Demographics
NPI:1932287117
Name:RODRIGUES, JOANN (MFT)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
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 1:125 RYAN INDUSTRIAL COURT
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1773
Mailing Address - Country:US
Mailing Address - Phone:925-820-4443
Mailing Address - Fax:
Practice Address - Street 1:2450 PERALTA BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536
Practice Address - Country:US
Practice Address - Phone:510-792-4058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21801106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist