Mrs. Jacqueline Rodriguez
Addiction Counselor (Substance Use Disorder)
243 Success Ave
Bridgeport
, Connecticut 06610-2429
Mrs. Jacqueline Rodriguez
Addiction Counselor (Substance Use Disorder)
243 Success Ave
Bridgeport
, Connecticut 06610-2429
(203) 864-8429
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About
Features
Specialties
- Addiction Counselor (Substance Use Disorder)
Languages spoken
- English
Location
First Address
- Mrs. Jacqueline Rodriguez
- 243 Success Ave
- Bridgeport, CT
- Zip : 06610-2429
- Phone : (203) 864-8429
Second Address
- Mrs. Jacqueline Rodriguez
- 243 Success Ave
- Bridgeport, CT
- Zip : 06610-2429
- Phone : (203) 864-8429
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 001104 | CT |
National Provider Identifier
| NPI | 1003288168 |
|---|---|
| Provider Name | Mrs. Jacqueline Rodriguez |
| First Address | Bridgeport, CT 06610-2429 |
| Second Address | Bridgeport, CT 06610-2429 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 28/10/2015 |
| Last Update Date | 31/10/2016 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 060669107 | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY (01) | CT |
| 060669107 | HEALTHYCT WELLMORE GRP/FACILITY (01) | CT |
| 060669107 | UBH- CONNECTICARE WELLMORE GRP/FACILITY (01) | CT |
| 060669107 | UBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY (01) | CT |
| 060669107 | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY (01) | CT |
| 060669107 | UNITED BEHAVIORAL HEALTH- OPTUM WELLMORE GRP/FACILITY (01) | CT |
| APP-5511 | APP ASSOCIATE PREVENTION PROFESSIONAL CCB (01) | CT |
| CAC-5511 | CAC- CERTIFIED ADDICTION COUNSELOR CCB (01) | CT |
| ICADC-5511 | ICADC INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR CCB (01) | CT |
| NOT ELIGIBLE | (02) | CT |
| PENDING | (05) | CT |
| PENDING | AETNA BEHAVIORAL HEALTH (01) | CT |
| PENDING | CAQH (01) | CT |
| PENDING | CIGNA BEHAVIORAL HEALTH (01) | CT |
| PENDING | MHN MANAGED HEALTH NETWORK (01) | CT |
| PENDING | MHN TRICARE NORTH (01) | CT |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.