Provider Demographics
NPI:1205929577
Name:RODRIGUEZ, JUNE (LPC, LADC)
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1674 ELLA T GRASSO BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2802
Mailing Address - Country:US
Mailing Address - Phone:203-296-0690
Mailing Address - Fax:203-900-0690
Practice Address - Street 1:30 HAZEL TERRACE
Practice Address - Street 2:SUITE C
Practice Address - City:WOODBRIDGE
Practice Address - State:CT
Practice Address - Zip Code:06525
Practice Address - Country:UM
Practice Address - Phone:203-296-0690
Practice Address - Fax:203-900-0690
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000272101YA0400X
CT002456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00415120500Medicaid