Provider Demographics
NPI:1023264066
Name:MOLINA RENDON, ALEJANDRO
Entity type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:
Last Name:MOLINA RENDON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 SOUTHFIELD AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7223
Mailing Address - Country:US
Mailing Address - Phone:929-233-6267
Mailing Address - Fax:
Practice Address - Street 1:68 SOUTHFIELD AVE
Practice Address - Street 2:STE 100
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7223
Practice Address - Country:US
Practice Address - Phone:929-233-6267
Practice Address - Fax:203-547-7335
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1339141041C0700X
CT0098131041C0700X
NJ44SL062162001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical