Provider Demographics
NPI:1891392585
Name:ROSENFELD, BROOKE ALYSSA (MS, RD, CPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALYSSA
Last Name:ROSENFELD
Suffix:
Gender:F
Credentials:MS, RD, CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 AUTUMN LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1329
Mailing Address - Country:US
Mailing Address - Phone:914-648-9398
Mailing Address - Fax:
Practice Address - Street 1:9 AUTUMN LN
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:CT
Practice Address - Zip Code:06413-1329
Practice Address - Country:US
Practice Address - Phone:914-648-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered