Healthcare Provider Details

I. General information

NPI: 1255773602
Provider Name (Legal Business Name): ROSE BARNES MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WATER ST
NORWICH CT
06360-5730
US

IV. Provider business mailing address

7B LEDGEBROOK DR
MANSFIELD CENTER CT
06250-1664
US

V. Phone/Fax

Practice location:
  • Phone: 860-425-5258
  • Fax: 203-397-9077
Mailing address:
  • Phone: 860-456-0038
  • Fax: 860-456-8765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: