Provider Demographics
NPI:1821696675
Name:RODRIGUEZ, BUNNY CATHERINA (MSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:BUNNY
Middle Name:CATHERINA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1252
Mailing Address - Country:US
Mailing Address - Phone:203-843-1915
Mailing Address - Fax:
Practice Address - Street 1:54 E RAMSDELL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1140
Practice Address - Country:US
Practice Address - Phone:203-337-9943
Practice Address - Fax:203-337-4395
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1389101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008039745Medicaid
CT008023170Medicaid
CT008024427Medicaid
CT008042339Medicaid