Provider Demographics
NPI:1417698069
Name:PRIVATE PRACTICE OF ADRIAN RODRIGUEZ TARGA LCSW
Entity Type:Organization
Organization Name:PRIVATE PRACTICE OF ADRIAN RODRIGUEZ TARGA LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ TARGA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-654-6699
Mailing Address - Street 1:57 PLAINS RD STE 33
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06461-2529
Mailing Address - Country:US
Mailing Address - Phone:203-654-6699
Mailing Address - Fax:
Practice Address - Street 1:57 PLAINS RD STE 33
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-2529
Practice Address - Country:US
Practice Address - Phone:203-654-6699
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-06
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty