Provider Demographics
NPI:1962994343
Name:RODRIGUEZ, AMBER LYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:LYN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AMBER
Other - Middle Name:LYN
Other - Last Name:MANFREDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:11332 PENSIVE PT APT 209
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-4306
Mailing Address - Country:US
Mailing Address - Phone:909-279-7997
Mailing Address - Fax:
Practice Address - Street 1:11332 PENSIVE PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-4304
Practice Address - Country:US
Practice Address - Phone:909-279-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-01
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1047921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical