Provider Demographics
NPI:1821281619
Name:RIVERA RODRIGUEZ, KATHLEEN R (MD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:RIVERA RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 WEST ST
Mailing Address - Street 2:WESTERN CT MEDICAL ST (UPPER LEVEL)
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-6361
Mailing Address - Country:US
Mailing Address - Phone:203-791-5140
Mailing Address - Fax:203-739-8959
Practice Address - Street 1:152 WEST ST
Practice Address - Street 2:WESTERN CT MEDICAL ST (UPPER LEVEL)
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6361
Practice Address - Country:US
Practice Address - Phone:203-791-5140
Practice Address - Fax:203-739-8959
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0476402084F0202X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry