Healthcare Provider Details

I. General information

NPI: 1255765160
Provider Name (Legal Business Name): TRUDY FRIEDBERG PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRUDY ROSENSTOCK

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 LEBANON RD # 3B
BOZRAH CT
06334-1116
US

IV. Provider business mailing address

46 LEBANON RD STE 3B
BOZRAH CT
06334-1116
US

V. Phone/Fax

Practice location:
  • Phone: 860-861-1722
  • Fax:
Mailing address:
  • Phone: 860-886-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001255
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: