Provider Demographics
NPI:1700943339
Name:RODRIGUEZ, HERMAN (PSYD, MFT)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15233 VENTURA BULVD
Mailing Address - Street 2:SUITE 1204
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-986-8539
Mailing Address - Fax:818-990-5143
Practice Address - Street 1:15233 VENTURA BLVD.
Practice Address - Street 2:SUITE 1204
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-986-8539
Practice Address - Fax:818-990-5143
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 32215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA148825OtherVALUE OPTIONS