Provider Demographics
NPI:1114316544
Name:WILSON, ROSANNA Z (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ROSANNA
Middle Name:Z
Last Name:WILSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2122
Mailing Address - Country:US
Mailing Address - Phone:860-946-0447
Mailing Address - Fax:
Practice Address - Street 1:1 KELLOGG ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3117
Practice Address - Country:US
Practice Address - Phone:860-219-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002679101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional