Provider Demographics
NPI:1629214465
Name:JENKINS, ROSA LEE (MS COUNSELING MS)
Entity Type:Individual
Prefix:MISS
First Name:ROSA
Middle Name:LEE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MS COUNSELING MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HANFORD PLACE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-3088
Mailing Address - Country:US
Mailing Address - Phone:203-945-2370
Mailing Address - Fax:203-945-2371
Practice Address - Street 1:11 HANFORD PLACE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-3088
Practice Address - Country:US
Practice Address - Phone:203-945-2370
Practice Address - Fax:203-945-2371
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT372600000X, 374U00000X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide