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General NPI Number Information
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NPI Number | 1215507165
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Entity Type | Individual
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Provider Name | JENNIFER ROSCHER
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Gender | Female
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Dates
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Enumeration Date | 07/01/2021
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Last Update Date | 07/01/2021
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Provider Practice Location Address
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Address Line | 225 N MAIN ST STE 106
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City | BRISTOL
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State | CT
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Zip | 06010-4993
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Country | US
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Telephone | 888-793-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 84 HARTLEY DR
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City | WATERBURY
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State | CT
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Zip | 06705-3735
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 2316
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License Number State | CT
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