Healthcare Provider Details

I. General information

NPI: 1003329756
Provider Name (Legal Business Name): JOANN ROTAR MS, NCC, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

869 WHALLEY AVE
NEW HAVEN CT
06515-1728
US

IV. Provider business mailing address

54 LAURIE PL
WATERBURY CT
06704-6102
US

V. Phone/Fax

Practice location:
  • Phone: 203-491-1652
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001836
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: