Provider Demographics
NPI:1982953584
Name:RODAS HURTADO, PRICILA MIUZETT (LCSW 94415)
Entity type:Individual
Prefix:
First Name:PRICILA
Middle Name:MIUZETT
Last Name:RODAS HURTADO
Suffix:
Gender:F
Credentials:LCSW 94415
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E. HUNTINGTON DR.
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010
Mailing Address - Country:US
Mailing Address - Phone:626-280-6510
Mailing Address - Fax:626-288-8903
Practice Address - Street 1:8263 GROVE AVE STE 201
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3107
Practice Address - Country:US
Practice Address - Phone:909-579-0708
Practice Address - Fax:909-579-0778
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71518104100000X
CA944151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker