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General NPI Number Information
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NPI Number | 1770326811
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Entity Type | Individual
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Provider Name | KIEFER MARLON RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 446A BLAKE ST
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City | NEW HAVEN
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State | CT
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Zip | 06515-4437
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Country | US
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Telephone | 203-387-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 26 LANDIN ST FL 1
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City | WOODBRIDGE
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State | CT
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Zip | 06525-2224
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Country | US
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Telephone | 203-999-4460
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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 | 9902
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 9902
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License Number State | CT
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