Provider Demographics
NPI:1740354190
Name:RODRIGUEZ, GRACIELA PILAR (LCSW, PSYD)
Entity type:Individual
Prefix:DR
First Name:GRACIELA
Middle Name:PILAR
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29532 AVANTE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-7949
Mailing Address - Country:US
Mailing Address - Phone:949-472-0226
Mailing Address - Fax:949-363-9185
Practice Address - Street 1:6B LIBERTY
Practice Address - Street 2:SUITE 115
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-5832
Practice Address - Country:US
Practice Address - Phone:949-472-0226
Practice Address - Fax:949-363-9185
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS134391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW13439AMedicare ID - Type UnspecifiedLCSW