Provider Demographics
NPI:1932370418
Name:RODRIGUEZ, SAMANTHA MARIA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:MARIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:MARIA
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17800 US HIGHWAY 18
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-1221
Mailing Address - Country:US
Mailing Address - Phone:760-946-8227
Mailing Address - Fax:760-946-5135
Practice Address - Street 1:14393 PARK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392
Practice Address - Country:US
Practice Address - Phone:442-327-9135
Practice Address - Fax:442-333-3140
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA92565106H00000X
CALMFT92565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor