| Doctor Name: | MRS. JACQUELINE RODRIGUEZ |
| NPI Number: | 1003288168 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LADC,ICADC,CAC,APP |
| License Number: | 001104 |
| Business Practice Address: | 402 E Main St Waterbury Op Adult Services Waterbury, CT - 067021701 |
| Business Phone Number: | 2037551143 |
| Business Fax Number: | 2037551455 |
| Mailing Address: | 141 E Main St, 4th Floor Administration WATERBURY |
| State: | CT |
| Postal Code: | 067022310 |
| Phone Number: | 2035749000 |
| Fax Number: | 2035749006 |
| NPI Enumeration Date: | 10/28/2015 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 001104 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |