Provider Demographics
NPI:1689973398
Name:HADE, ROSELYN (MFT)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:
Last Name:HADE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 CLAPBOARD RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752-1338
Mailing Address - Country:US
Mailing Address - Phone:203-417-1649
Mailing Address - Fax:
Practice Address - Street 1:232 CLAPBOARD RD
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:CT
Practice Address - Zip Code:06752-1338
Practice Address - Country:US
Practice Address - Phone:203-417-1649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist