Healthcare Provider Details

I. General information

NPI: 1659878411
Provider Name (Legal Business Name): SONIA ROITMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2018
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 1ST ST
STAMFORD CT
06905-5101
US

IV. Provider business mailing address

153 TURNER RD
STAMFORD CT
06905-3605
US

V. Phone/Fax

Practice location:
  • Phone: 203-561-2037
  • Fax:
Mailing address:
  • Phone: 203-561-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number002348
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002348
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: