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General NPI Number Information
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NPI Number | 1750063525
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Entity Type | Individual
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Provider Name | AURIVELLISE RODRIGUEZ
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Gender | Female
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 345 N MAIN ST STE 317
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City | WEST HARTFORD
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State | CT
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Zip | 06117-2508
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Country | US
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Telephone | 860-888-3686
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Fax |
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Provider Business Mailing Address
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Address Line | 46 MOUNTAIN ST
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City | HARTFORD
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State | CT
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Zip | 06106-4239
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Country | US
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Telephone | 860-888-3686
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6556
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License Number State | CT
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