MEDICARE: PRIVATE PRACTICE OF ADRIAN RODRIGUEZ TARGA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1417698069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVATE PRACTICE OF ADRIAN RODRIGUEZ TARGA LCSW

Provider Business Mailing Address
First Line	:	57 PLAINS RD STE 33
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06461-2529
Country	:	US
Telephone Number	:	203-654-6699
Fax Number	:

Provider Business Practice Location Address
First Line	:	57 PLAINS RD STE 33
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06461-2529
Country	:	US
Telephone Number	:	203-654-6699
Fax Number	:

Authorized Official
Title or Position	:	PROVIDER
Name	:	ADRIAN RODRIGUEZ TARGA
Credential	:	LCSW
Telephone Number	:	203-654-6699

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	03/29/2024

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