Healthcare Provider Details

I. General information

NPI: 1346309507
Provider Name (Legal Business Name): WAYNE DAVID ROSENFIELD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 POMFRET ST DAY KIMBALL HEALTHCARE
PUTNAM CT
06260-1836
US

IV. Provider business mailing address

320 POMFRET ST DAY KIMBALL HEALTHCARE
PUTNAM CT
06260-1836
US

V. Phone/Fax

Practice location:
  • Phone: 860-963-6385
  • Fax: 860-963-6393
Mailing address:
  • Phone: 860-963-6385
  • Fax: 860-963-6393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000935
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number000935
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number000935
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number000935
License Number StateCT
# 5
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number000935
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: