MEDICARE: MR. ADRIAN MIGUEL 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	104100000X	Social Worker	3826	CT
2	1041C0700X	Clinical Social Worker	10806	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477076677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ADRIAN MIGUEL 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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2017
Last Update Date	:	03/29/2024

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