Provider Demographics
NPI:1336967975
Name:RODRIGUEZ-PRADO, COURTNEY LYNN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:RODRIGUEZ-PRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:LARANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:947 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1634
Mailing Address - Country:US
Mailing Address - Phone:401-824-9262
Mailing Address - Fax:
Practice Address - Street 1:77 HARTLAND ST STE 108
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3259
Practice Address - Country:US
Practice Address - Phone:888-754-0398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician