Provider Demographics
NPI:1780980755
Name:ROSIN, ANNE MICHELLE (PHD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MICHELLE
Last Name:ROSIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 WARWICK RD
Mailing Address - Street 2:
Mailing Address - City:NEW FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06812-3130
Mailing Address - Country:US
Mailing Address - Phone:845-803-4830
Mailing Address - Fax:
Practice Address - Street 1:53 WARWICK RD
Practice Address - Street 2:
Practice Address - City:NEW FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06812-3130
Practice Address - Country:US
Practice Address - Phone:845-803-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016035103TC1900X
CT3005103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling