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General NPI Number Information
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NPI Number | 1871196550
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Entity Type | Organization
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Legal Business Name | ROSE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 11/17/2020
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Last Update Date | 11/17/2020
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Provider Practice Location Address
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Address Line | 168 BRADLEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06514-3909
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Country | US
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Telephone | 678-235-4194
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Fax |
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Provider Business Mailing Address
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Address Line | 185 ALDEN AVE
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City | NEW HAVEN
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State | CT
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Zip | 06515-2109
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Country | US
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Telephone | 678-708-6396
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EMILY LORIN
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Credential | LPC
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Telephone | 678-708-6396
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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