Healthcare Provider Details

I. General information

NPI: 1972673739
Provider Name (Legal Business Name): JOANNA LIFSHEY ROSEN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON AVE STE 4
SANDY HOOK CT
06482-1363
US

IV. Provider business mailing address

60 SUGAR LN
NEWTOWN CT
06470-1768
US

V. Phone/Fax

Practice location:
  • Phone: 203-482-9274
  • Fax:
Mailing address:
  • Phone: 203-482-9274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number002332
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: