Healthcare Provider Details

I. General information

NPI: 1528600160
Provider Name (Legal Business Name): ANTONELLA ROSA SFERRAZZA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

IV. Provider business mailing address

54 ROPE FERRY RD UNIT 58
WATERFORD CT
06385-2824
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-3438
  • Fax:
Mailing address:
  • Phone: 860-235-4878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2793
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: