Healthcare Provider Details

I. General information

NPI: 1205013315
Provider Name (Legal Business Name): JUSTIN ANDREW ROGALA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK ST OFFICE 215 CONNECTICUT MENTAL HEALTH CENTER
NEW HAVEN CT
06519-1109
US

IV. Provider business mailing address

34 PARK ST OFFICE 215 CONNECTICUT MENTAL HEALTH CENTER
NEW HAVEN CT
06519-1109
US

V. Phone/Fax

Practice location:
  • Phone: 203-974-7044
  • Fax: 203-974-7322
Mailing address:
  • Phone: 203-974-7044
  • Fax: 203-974-7322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number006512
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: