Individual
MRS. JACQUELINE RODRIGUEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC,CAC,APP
Contact information
Practice address
243 SUCCESS AVE, BRIDGEPORT, CT 06610-2429
(203) 864-8429
Mailing address
243 SUCCESS AVE, BRIDGEPORT, CT 06610-2429
(203) 864-8429
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
001104
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060669107
HEALTHYCT WELLMORE GRP/FACILITY
CT
01
—
APP-5511
APP ASSOCIATE PREVENTION PROFESSIONAL CCB
CT
01
—
CAC-5511
CAC- CERTIFIED ADDICTION COUNSELOR CCB
CT
01
—
ICADC-5511
ICADC INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR CCB
CT
01
—
PENDING
AETNA BEHAVIORAL HEALTH
CT
05
—
PENDING
—
CT
Enumeration date
10/28/2015
Last updated
10/31/2016
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