Provider Demographics
NPI:1013281070
Name:RENDON, GEORGE ROGER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ROGER
Last Name:RENDON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:479 PACIFIC ST
Mailing Address - Street 2:STE. 2A
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2716
Mailing Address - Country:US
Mailing Address - Phone:831-372-1070
Mailing Address - Fax:831-655-1229
Practice Address - Street 1:479 PACIFIC ST
Practice Address - Street 2:STE. 2A
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2716
Practice Address - Country:US
Practice Address - Phone:831-372-1070
Practice Address - Fax:831-655-1229
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical