Provider Demographics
NPI:1932763935
Name:ROSEN, DEBORAH K (LPC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-4704
Mailing Address - Country:US
Mailing Address - Phone:917-817-5940
Mailing Address - Fax:
Practice Address - Street 1:357 WHITNEY AVE STE 201
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-2364
Practice Address - Country:US
Practice Address - Phone:917-817-5940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-24
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional