Provider Demographics
NPI:1467403576
Name:ROSENFIELD, HERBERT JAY (ACSW, LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:HERBERT
Middle Name:JAY
Last Name:ROSENFIELD
Suffix:
Gender:M
Credentials:ACSW, LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 S MAIN ST (SUITE 23)
Mailing Address - Street 2:ADOLESCENT & FAMILY COUNSELING CENTER, LLC
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3160
Mailing Address - Country:US
Mailing Address - Phone:203-271-1234
Mailing Address - Fax:203-272-9094
Practice Address - Street 1:350 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3160
Practice Address - Country:US
Practice Address - Phone:203-271-1234
Practice Address - Fax:203-272-9094
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT134358OtherVO
CT140000187CT01OtherBCBS
CT4106619OtherAETNA