Provider Demographics
NPI:1033510581
Name:RODRIGUEZ, KELLY ANN (LPC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:DECAMPOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:420 HIGHLAND AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2527
Mailing Address - Country:US
Mailing Address - Phone:203-931-5566
Mailing Address - Fax:888-531-8142
Practice Address - Street 1:420 HIGHLAND AVE STE B1
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2527
Practice Address - Country:US
Practice Address - Phone:203-931-5566
Practice Address - Fax:888-531-8142
Is Sole Proprietor?:No
Enumeration Date:2014-09-15
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7499101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional