Healthcare Provider Details

I. General information

NPI: 1477622579
Provider Name (Legal Business Name): STANLEY ROSNER & BLANCHE A. ROSNER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SAW MILL RD
STAMFORD CT
06903
US

IV. Provider business mailing address

415 SAW MILL RD
STAMFORD CT
06903
US

V. Phone/Fax

Practice location:
  • Phone: 203-329-1578
  • Fax: 203-329-0514
Mailing address:
  • Phone: 203-329-1578
  • Fax: 203-329-0514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number000115
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number001497
License Number StateCT

VIII. Authorized Official

Name: DR. STANLEY ROSNER
Title or Position: LLC - OWNER
Credential: PHD
Phone: 203-329-1578