Healthcare Provider Details

I. General information

NPI: 1861332371
Provider Name (Legal Business Name): MIXTLI ITZEL RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 HOSPITAL AVE STE 301
DANBURY CT
06810-5994
US

IV. Provider business mailing address

4 MOUNTAINVILLE RD
DANBURY CT
06810-8435
US

V. Phone/Fax

Practice location:
  • Phone: 203-778-2437
  • Fax: 203-885-7202
Mailing address:
  • Phone: 203-726-0820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: