Healthcare Provider Details

I. General information

NPI: 1568940740
Provider Name (Legal Business Name): ROSEANNE APRIL RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 PALM AVE
LA MESA CA
91941-5266
US

IV. Provider business mailing address

PO BOX 182
HIGHLAND CA
92346-0182
US

V. Phone/Fax

Practice location:
  • Phone: 619-317-0085
  • Fax:
Mailing address:
  • Phone: 909-810-9302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW116017
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: