Provider Demographics
NPI:1053854406
Name:ROSENBLOOM, CARRIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ROSENBLOOM
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WALDEN WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-1327
Mailing Address - Country:US
Mailing Address - Phone:203-246-2002
Mailing Address - Fax:
Practice Address - Street 1:98 EAST AVE
Practice Address - Street 2:REAR BLDG
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5029
Practice Address - Country:US
Practice Address - Phone:203-246-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1864106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist