Healthcare Provider Details

I. General information

NPI: 1780548784
Provider Name (Legal Business Name): BRENDA ITSEL RODRIGUEZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1009 E CYPRESS AVE
REDLANDS CA
92374-5308
US

IV. Provider business mailing address

1009 E CYPRESS AVE
REDLANDS CA
92374-5308
US

V. Phone/Fax

Practice location:
  • Phone: 909-261-6930
  • Fax:
Mailing address:
  • Phone: 909-261-6930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number131920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: