Healthcare Provider Details

I. General information

NPI: 1245321629
Provider Name (Legal Business Name): STACEY BETH ROVINSKY BSW,CPRP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

190 WESTFORT DR
MERIDEN CT
06451-3600
US

V. Phone/Fax

Practice location:
  • Phone: 203-931-4010
  • Fax:
Mailing address:
  • Phone: 203-634-9264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: