Provider Demographics
NPI:1568564755
Name:ROSENBERG, JUDITH H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:H
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1268 MAIN ST
Mailing Address - Street 2:JUDITH H ROSENBERG PHD
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-667-3043
Mailing Address - Fax:860-667-3043
Practice Address - Street 1:1268 MAIN ST
Practice Address - Street 2:JUDITH H ROSENBERG PHD
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111
Practice Address - Country:US
Practice Address - Phone:860-667-3043
Practice Address - Fax:860-667-3043
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1232PSYC103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist