Healthcare Provider Details

I. General information

NPI: 1841822871
Provider Name (Legal Business Name): DANIELLE RODRIGUEZ MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PROGRESS DR UNIT 2B
SHELTON CT
06484
US

IV. Provider business mailing address

276 SAMS ROAD UNIT C
MERIDEN CT
06451-7520
US

V. Phone/Fax

Practice location:
  • Phone: 475-239-5512
  • Fax:
Mailing address:
  • Phone: 203-832-4389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-37044
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: