Provider Demographics
NPI:1134301153
Name:HARRAN RODRIGUEZ, TERRY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:
Last Name:HARRAN 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 1:34 MURRAY STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710
Mailing Address - Country:US
Mailing Address - Phone:203-756-8317
Mailing Address - Fax:203-756-8317
Practice Address - Street 1:34 MURRAY STREET
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710
Practice Address - Country:US
Practice Address - Phone:203-756-8317
Practice Address - Fax:203-756-8310
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0056221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004068284Medicaid
CT800003615Medicare UPIN