Provider Demographics
NPI:1528209939
Name:DR. JOANNA L. ROSEN, LLC
Entity Type:Organization
Organization Name:DR. JOANNA L. ROSEN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:203-482-9274
Mailing Address - Street 1:60 SUGAR LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-1768
Mailing Address - Country:US
Mailing Address - Phone:203-482-9274
Mailing Address - Fax:
Practice Address - Street 1:15 BERKSHIRE RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1361
Practice Address - Country:US
Practice Address - Phone:203-482-9274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty