MEDICARE: ROSANN RAFALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1144922808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSANN RAFALA

Provider Business Mailing Address
First Line	:	35 LAUNCHING AREA RD
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 LAUNCHING AREA RD
Second Line	:
City	:	EAST HADDAM
State	:	CT
Zip	:	06423-1036
Country	:	US
Telephone Number	:	860-212-3994
Fax Number	:

Authorized Official
Title or Position	:	LICENSED ALCOHOL DRUG COUNSELOR
Name	:	ROSANN RAFALA
Credential	:
Telephone Number	:	860-212-3994

Provider Enumeration Date	:	03/20/2023
Last Update Date	:	03/20/2023

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