Provider Demographics
NPI:1346309507
Name:ROSENFIELD, WAYNE DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:DAVID
Last Name:ROSENFIELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 POMFRET ST
Mailing Address - Street 2:DAY KIMBALL HEALTHCARE
Mailing Address - City:PUTNAM
Mailing Address - State:CT
Mailing Address - Zip Code:06260-1836
Mailing Address - Country:US
Mailing Address - Phone:860-963-6385
Mailing Address - Fax:860-963-6393
Practice Address - Street 1:320 POMFRET ST
Practice Address - Street 2:DAY KIMBALL HEALTHCARE
Practice Address - City:PUTNAM
Practice Address - State:CT
Practice Address - Zip Code:06260-1836
Practice Address - Country:US
Practice Address - Phone:860-963-6385
Practice Address - Fax:860-963-6393
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000935103T00000X, 103TB0200X, 103TM1800X, 103TS0200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008036465Medicaid
CTD400055203Medicare PIN