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General NPI Number Information
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NPI Number | 1134769615
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Entity Type | Individual
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Provider Name | RODRIGO FERNANDO VILLEGAS LCSW
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Gender | Male
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Dates
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Enumeration Date | 01/13/2020
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 883 PADDOCK AVE
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City | MERIDEN
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State | CT
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Zip | 06450-7044
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Country | US
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Telephone | 203-630-5327
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Fax |
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Provider Business Mailing Address
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Address Line | 100 STATE ST APT 129
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City | NORTH HAVEN
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State | CT
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Zip | 06473-2225
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Country | US
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Telephone | 914-819-8115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 4892
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License Number State | CT
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