Individual provider Active NPI

Kimberly Alexis Rodriguez, LCSW

  • Clinical Social Worker
  • Waterbury, CT
National Provider Identifier
1477017028
Registry record updated Sep 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
12410 Issued in CT
Practice address
51 N Elm St
Waterbury, CT 06702-1545
Phone
(203) 574-4000
Fax
(203) 574-4003
NPI assigned
Jan 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 12410 CT Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

51 N Elm St
Waterbury, CT 06702-1545

Mailing address

19 Grand St
Middletown, CT 06457-2705
Phone (860) 347-6971

Other practice location 1

75 N Mountain Rd
New Britain, CT 06053-3468
Phone (860) 793-3500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220929002173 CT Practitioner - Clinical Social Worker 1759767635 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12410CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Center Inc CurrentSince Jul 11, 2025 Accepting new patients
Community Health Center Inc Clinical CurrentSince Jul 11, 2025 Accepting new patients

Locations

19 Grand St
Middletown, CT 06457
Phone (860) 323-0172

51 N Elm St
Waterbury, CT 06702
Phone (203) 574-4000

Interoperability endpoints

  • Direct secure messaging: kimberly.rodriguez.p1@direct.wheelerclinic.nextgenshare.com

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757376000000",
    "number": "1477017028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 GRAND ST",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572705",
            "telephone_number": "860-347-6971",
            "fax_number": "860-343-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N ELM ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021545",
            "telephone_number": "203-574-4000",
            "fax_number": "203-574-4003"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "75 N Mountain Rd",
            "address_purpose": "LOCATION",
            "city": "New Britain",
            "state": "CT",
            "postal_code": "060533468",
            "country_code": "US",
            "telephone_number": "860-793-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "KIMBERLY",
        "middle_name": "ALEXIS",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2025-09-09",
        "certification_date": "2025-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "12410",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.