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General NPI Number Information
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NPI Number | 1477017028
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Entity Type | Individual
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Provider Name | KIMBERLY ALEXIS RODRIGUEZ LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 51 N ELM ST
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City | WATERBURY
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State | CT
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Zip | 06702-1545
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Country | US
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Telephone | 203-574-4000
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Fax | 203-574-4003
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Provider Business Mailing Address
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Address Line | 19 GRAND ST
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City | MIDDLETOWN
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State | CT
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Zip | 06457-2705
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Country | US
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Telephone | 860-347-6971
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Fax | 860-343-7379
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 12410
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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