Provider Demographics
NPI:1073312724
Name:GRACE, ROSEMARY
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:GRACE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GOSHEN RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-3700
Mailing Address - Country:US
Mailing Address - Phone:860-705-4282
Mailing Address - Fax:
Practice Address - Street 1:42 GOSHEN RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-3700
Practice Address - Country:US
Practice Address - Phone:860-705-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT402103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst