Provider Demographics
NPI:1104233261
Name:RODRIGUEZ, LACY
Entity type:Individual
Prefix:
First Name:LACY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28504 MISSION BLVD
Mailing Address - Street 2:APT 905
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4972
Mailing Address - Country:US
Mailing Address - Phone:530-635-3080
Mailing Address - Fax:
Practice Address - Street 1:1000 SAN LEANDRO BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-1598
Practice Address - Country:US
Practice Address - Phone:510-351-1367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker