Provider Demographics
NPI:1477076677
Name:RODRIGUEZ-TARGA, ADRIAN MIGUEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADRIAN
Middle Name:MIGUEL
Last Name:RODRIGUEZ-TARGA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 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:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3826104100000X
CT108061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid