=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528209939
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR. JOANNA L. ROSEN, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2009
-----------------------------------------------------
Last Update Date | 03/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 BERKSHIRE RD
-----------------------------------------------------
City | SANDY HOOK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06482-1361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-482-9274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 SUGAR LN
-----------------------------------------------------
City | NEWTOWN
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06470-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-482-9274
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JOANNA L ROSEN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 203-482-9274
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------