Basic Information
| Provider Information | |||||||||
| NPI: | 1386779833 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANUELOS RODRIGUEZ | ||||||||
| FirstName: | EMERITA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1799 ESPLANADE WAY | ||||||||
| Address2: | 1965 LIVE OAK BLVD. | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959931011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304151874 | ||||||||
| FaxNumber: | 5306710943 | ||||||||
| Practice Location | |||||||||
| Address1: | 1799 ESPLANADE WAY | ||||||||
| Address2: | 1965 LIVE OAK BLVD. | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959931011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5304151874 | ||||||||
| FaxNumber: | 5306710943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2007 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.