Provider Demographics
NPI:1447564265
Name:RODRIGUEZ, GAITAN R JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:GAITAN
Middle Name:R
Last Name:RODRIGUEZ
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FRANKLIN SQ
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06051-2607
Mailing Address - Country:US
Mailing Address - Phone:860-225-3561
Mailing Address - Fax:860-225-2558
Practice Address - Street 1:90 FRANKLIN SQ
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2607
Practice Address - Country:US
Practice Address - Phone:860-225-3561
Practice Address - Fax:860-225-2558
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker