Provider Demographics
NPI:1477739381
Name:ROSNER, ELISA B (PSYD)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:B
Last Name:ROSNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3508
Mailing Address - Country:US
Mailing Address - Phone:917-312-9886
Mailing Address - Fax:
Practice Address - Street 1:415 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-3508
Practice Address - Country:US
Practice Address - Phone:917-312-9886
Practice Address - Fax:203-329-0554
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001912103TC0700X
NY011616-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical