Provider Demographics
NPI:1023387594
Name:QUINONES-RODRIGUEZ, GRACIELA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:GRACIELA
Middle Name:
Last Name:QUINONES-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:UNIVERSITY OF CONNECTICUT HEALTH SERVICES ANX
Mailing Address - Street 2:234 GLENBROOK RD., UNIT 2011
Mailing Address - City:STORRS
Mailing Address - State:CT
Mailing Address - Zip Code:06269-2011
Mailing Address - Country:US
Mailing Address - Phone:860-486-4705
Mailing Address - Fax:860-486-9159
Practice Address - Street 1:234 GLENBROOK RD.
Practice Address - Street 2:UNIT 2011-ANNEX
Practice Address - City:STORRS
Practice Address - State:CT
Practice Address - Zip Code:06269-2011
Practice Address - Country:US
Practice Address - Phone:860-486-4705
Practice Address - Fax:860-486-9159
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical