Provider Demographics
NPI:1710271101
Name:RODRIGUEZ, SUHAIL DARIE (MS, LPC, LADC)
Entity Type:Individual
Prefix:MS
First Name:SUHAIL
Middle Name:DARIE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MS, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3324
Mailing Address - Country:US
Mailing Address - Phone:203-935-7164
Mailing Address - Fax:
Practice Address - Street 1:357 WHITNEY AVENUE
Practice Address - Street 2:G-05 REAR
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-779-6811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000815101YA0400X
CT003267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008077718Medicaid