Basic Information
| Provider Information | |||||||||
| NPI: | 1194193482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | CRISTINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MSW,BA,LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 E MAIN ST | ||||||||
| Address2: | 4TH FLOOR ADMINISTRATION | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035749000 | ||||||||
| FaxNumber: | 2035749006 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 E MAIN ST | ||||||||
| Address2: | HOME BASED SERVICES 3RD FLOOR | ||||||||
| City: | WATERBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067022310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2035750466 | ||||||||
| FaxNumber: | 2035751817 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 08/29/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 002046 | CT | Y | Behavioral Health & Social Service Providers | Social Worker |
ID Information
| ID | Type | State | Issuer | Description | 060669107 | 01 | CT | UBH -CONNECTICARE WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | UBH- UNITED HEALTHCARE WELLMORE GRP/FACILITY | OTHER | D339209- 141 E MAIN | 01 | CT | VALUE OPTIONS | OTHER | PENDING | 01 | CT | CIGNA BEHAVIORAL HEALTH | OTHER | 060669107 | 01 | CT | HEALTHYCT GRP/FACILITY | OTHER | 060669107 | 01 | CT | UNITED BEHAVIORAL HEALTH WELLMORE GRP/FACILITY | OTHER | 060669107 | 01 | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY | OTHER | NOT ELIGIBLE | 01 | CT | MHN MANAGED HEALTH NETWORK | OTHER | PENDING | 01 | CT | AETNA BEHAVIORAL HEALTH | OTHER | 008062547 | 05 | CT | MEDICAID | 13671480 | 01 | CT | CAQH | OTHER | 060669107 | 01 | CT | UBH-LIBERTY/OXFORD HEALTH PLANS WELLMORE GRP/FACILITY | OTHER | NOT ELIGIBLE | 01 | CT | MHN TRICARE NORTH | OTHER |