Provider Demographics
NPI:1205139649
Name:RODRIGUEZ, ANTHONY EDWARD (LMFT)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:EDWARD
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SEABRIGHT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3455
Mailing Address - Country:US
Mailing Address - Phone:831-566-0158
Mailing Address - Fax:
Practice Address - Street 1:711 SEABRIGHT AVE APT 1
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062
Practice Address - Country:US
Practice Address - Phone:831-566-0158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86277106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist