Healthcare Provider Details

I. General information

NPI: 1609698836
Provider Name (Legal Business Name): ROSA LEE SMITH MSC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

846 WETHERSFIELD AVE STE 101
HARTFORD CT
06114-3180
US

IV. Provider business mailing address

57 BROOKWOOD DR APT C
ROCKY HILL CT
06067-2723
US

V. Phone/Fax

Practice location:
  • Phone: 860-962-1803
  • Fax:
Mailing address:
  • Phone: 959-223-0187
  • Fax: 203-590-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: