Provider Demographics
NPI:1558867366
Name:RODRIGUEZ, KAREN (RBT)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CORPORATE CENTER DR STE 170
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8737
Mailing Address - Country:US
Mailing Address - Phone:866-417-8669
Mailing Address - Fax:
Practice Address - Street 1:410 S MELROSE DR STE 100
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6607
Practice Address - Country:US
Practice Address - Phone:866-417-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-19-86136106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician