Provider Demographics
NPI:1013097187
Name:RHODES, VIRGINIA BECKER (LCSW)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BECKER
Last Name:RHODES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 MIDDLESEX TPKE
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1317
Mailing Address - Country:US
Mailing Address - Phone:860-395-0111
Mailing Address - Fax:860-395-1264
Practice Address - Street 1:841 MIDDLESEX TPKE
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1317
Practice Address - Country:US
Practice Address - Phone:860-395-0111
Practice Address - Fax:860-395-1264
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical