Provider Demographics
NPI:1972673739
Name:ROSEN, JOANNA LIFSHEY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:LIFSHEY
Last Name:ROSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1 WASHINGTON AVE STE 4
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1363
Practice Address - Country:US
Practice Address - Phone:203-482-9274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002332CT01OtherANTHEM BLUE CROSS BLUE SH
CT348173OtherMHN
CT680001680Medicare ID - Type Unspecified