Individual
EVELYN RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED
Contact information
Practice address
141 E MAIN ST, 3RD FLOOR HOME BASED SERVICES, WATERBURY, CT 06702-2310
(203) 575-0466
(203) 575-1817
Mailing address
141 E MAIN ST, 4TH FLOOR ADMINISTRATION, WATERBURY, CT 06702-2310
(203) 574-9000
(203) 574-9006
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1777
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008062548
—
CT
01
—
13671482
CAQH
CT
01
—
PROVISIONAL EDUCATOR
BLOOMFIELD SCHOOL DISTRICT-PROVISIONAL EDUCATOR
CT
Enumeration date
04/15/2014
Last updated
08/15/2016
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