Provider Demographics
NPI:1447403225
Name:ROSA, PAMELA ELIZABETH (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:ROSA
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 1:141 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-3098
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-759-5610
Practice Address - Street 1:141 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-3098
Practice Address - Country:US
Practice Address - Phone:203-574-9000
Practice Address - Fax:203-759-5610
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-24
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional