Basic Information
| Provider Information | |||||||||
| NPI: | 1417143074 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LINKOVICH | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | BETH | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 132 GROVE ST | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067905047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604285558 | ||||||||
| FaxNumber: | 8604892984 | ||||||||
| Practice Location | |||||||||
| Address1: | 132 GROVE STREET | ||||||||
| Address2: | |||||||||
| City: | TORRINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 067905047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8604825558 | ||||||||
| FaxNumber: | 8604982984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2007 | ||||||||
| LastUpdateDate: | 08/12/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 007524 | CT | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.