Provider Demographics
NPI:1730706524
Name:GRIJALBA-RODRIGUEZ, CAROLINA (LCSW)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:GRIJALBA-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 1:155 MAIN ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-7844
Mailing Address - Country:US
Mailing Address - Phone:203-739-0035
Mailing Address - Fax:203-739-0035
Practice Address - Street 1:155 MAIN ST STE 205
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-7844
Practice Address - Country:US
Practice Address - Phone:203-739-0035
Practice Address - Fax:203-739-0035
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty