Provider Demographics
NPI:1295929685
Name:RODRIGUEZ, GUADALUPE (LCSW #26961)
Entity type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW #26961
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2613 HARKNESS ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2327
Mailing Address - Country:US
Mailing Address - Phone:916-396-0835
Mailing Address - Fax:
Practice Address - Street 1:2613 HARKNESS ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2327
Practice Address - Country:US
Practice Address - Phone:916-396-0835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 251S00000X
CALCS269611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA38CBINOtherHORIZONS MHSA
CA38241OtherHORIZONS SA SERVICES
CA943007538OtherASIAN AMERICAN RECOVERY