Basic Information
| Provider Information | |||||||||
| NPI: | 1578827663 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | BRENDA | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1828 E CESAR E CHAVEZ AVE STE 6100 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332597 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238593634 | ||||||||
| FaxNumber: | 3239871212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1328 W MANCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900442240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237789595 | ||||||||
| FaxNumber: | 3237780028 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2012 | ||||||||
| LastUpdateDate: | 12/10/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | 86663 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.