Provider Demographics
NPI:1477017028
Name:RODRIGUEZ, KIMBERLY ALEXIS (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ALEXIS
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-2705
Mailing Address - Country:US
Mailing Address - Phone:860-347-6971
Mailing Address - Fax:860-343-7379
Practice Address - Street 1:51 N ELM ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-1545
Practice Address - Country:US
Practice Address - Phone:203-574-4000
Practice Address - Fax:203-574-4003
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT124101041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program