Provider Demographics
NPI:1225718240
Name:RODRIGUEZ, ELIZABETH T (LMSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 STATE PIER RD APT F8
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5845
Mailing Address - Country:US
Mailing Address - Phone:857-625-3838
Mailing Address - Fax:
Practice Address - Street 1:400 BAYONET ST
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-2600
Practice Address - Country:US
Practice Address - Phone:857-207-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7679104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker