Provider Demographics
NPI:1033823257
Name:ROSENFELD, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WILD ROSE CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-1690
Mailing Address - Country:US
Mailing Address - Phone:860-205-1743
Mailing Address - Fax:
Practice Address - Street 1:34 WILD ROSE CT
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-1690
Practice Address - Country:US
Practice Address - Phone:860-205-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health