Provider Demographics
NPI:1386779833
Name:BANUELOS RODRIGUEZ, EMERITA (LCSW)
Entity type:Individual
Prefix:MS
First Name:EMERITA
Middle Name:
Last Name:BANUELOS RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1799 ESPLANADE WAY
Mailing Address - Street 2:1965 LIVE OAK BLVD.
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-1011
Mailing Address - Country:US
Mailing Address - Phone:530-415-1874
Mailing Address - Fax:530-671-0943
Practice Address - Street 1:1799 ESPLANADE WAY
Practice Address - Street 2:1965 LIVE OAK BLVD.
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-1011
Practice Address - Country:US
Practice Address - Phone:530-415-1874
Practice Address - Fax:530-671-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical