Active NPI
Jacqueline Rodriguez, LADC,CAC,APP
- Addiction (Substance Use Disorder) Counselor
- Bridgeport, CT
National Provider Identifier
1003288168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 001104
- Practice address
- 243 Success Ave
Bridgeport, CT 06610-2429 - Phone
- (203) 864-8429
- NPI assigned
- Oct 28, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 001104 | CT | Primary |
Addresses
Primary practice location
243 Success Ave
Bridgeport, CT 06610-2429
Mailing address
243 Success Ave
Bridgeport, CT 06610-2429
Phone (203) 864-8429
Other identifiers 15
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060669107 | Other | CT | HEALTHYCT WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | UBH- CONNECTICARE WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY |
| ICADC-5511 | Other | CT | ICADC INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR CCB |
| CAC-5511 | Other | CT | CAC- CERTIFIED ADDICTION COUNSELOR CCB |
| PENDING | Other | CT | AETNA BEHAVIORAL HEALTH |
| PENDING | Other | CT | CAQH |
| PENDING | Other | CT | MHN MANAGED HEALTH NETWORK |
| 060669107 | Other | CT | UNITED BEHAVIORAL HEALTH- OPTUM WELLMORE GRP/FACILITY |
| 060669107 | Other | CT | UBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY |
| APP-5511 | Other | CT | APP ASSOCIATE PREVENTION PROFESSIONAL CCB |
| 060669107 | Other | CT | ANTHEM BCBS OF CT WELLMORE GRP/FACILITY |
| PENDING | Other | CT | CIGNA BEHAVIORAL HEALTH |
| PENDING | Other | CT | MHN TRICARE NORTH |
| PENDING | Medicaid | CT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001104 | CT | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477872000000",
"number": "1003288168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "243 SUCCESS AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066102429",
"telephone_number": "203-864-8429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "243 SUCCESS AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066102429",
"telephone_number": "203-864-8429"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RODRIGUEZ",
"first_name": "JACQUELINE",
"name_prefix": "Mrs.",
"credential": "LADC,CAC,APP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-28",
"last_updated": "2016-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CT",
"license": "001104",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHYCT WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH- CONNECTICARE WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ICADC INTERNATIONALLY CERTIFIED ADDICTION COUNSELOR CCB",
"identifier": "ICADC-5511",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAC- CERTIFIED ADDICTION COUNSELOR CCB",
"identifier": "CAC-5511",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA BEHAVIORAL HEALTH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN MANAGED HEALTH NETWORK",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED BEHAVIORAL HEALTH- OPTUM WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UBH-OXFORD HEALTH LIBERTY/FREEDOM WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "APP ASSOCIATE PREVENTION PROFESSIONAL CCB",
"identifier": "APP-5511",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS OF CT WELLMORE GRP/FACILITY",
"identifier": "060669107",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN TRICARE NORTH",
"identifier": "PENDING",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PENDING",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.