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General NPI Number Information
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NPI Number | 1710271101
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Entity Type | Individual
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Provider Name | SUHAIL DARIE RODRIGUEZ MS, LPC, LADC
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Gender | Female
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Dates
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Enumeration Date | 06/03/2011
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 357 WHITNEY AVENUE G-05 REAR
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City | NEW HAVEN
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State | CT
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Zip | 06511
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Country | US
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Telephone | 203-779-6811
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Fax |
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Provider Business Mailing Address
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Address Line | 140 COLONY ST
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City | HAMDEN
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State | CT
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Zip | 06518-3324
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Country | US
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Telephone | 203-935-7164
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 000815
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 003267
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License Number State | CT
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