Healthcare Provider Details

I. General information

NPI: 1508602962
Provider Name (Legal Business Name): RODRIGO SAMPAIO MARTINS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 WEST ST
DANBURY CT
06810-6528
US

IV. Provider business mailing address

77 WEST ST
DANBURY CT
06810-6528
US

V. Phone/Fax

Practice location:
  • Phone: 475-206-3078
  • Fax:
Mailing address:
  • Phone: 475-206-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number16531
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: