Provider Demographics
NPI:1962543082
Name:ROSEN, ROBIN G (LADC)
Entity type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:G
Last Name:ROSEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 MERROW RD STE D
Mailing Address - Street 2:
Mailing Address - City:TOLLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06084-3957
Mailing Address - Country:US
Mailing Address - Phone:860-875-2578
Mailing Address - Fax:860-875-9963
Practice Address - Street 1:384 MERROW RD STE D
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3957
Practice Address - Country:US
Practice Address - Phone:860-875-2578
Practice Address - Fax:860-875-9963
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000365101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT300000365CT01OtherANTHEM BLUE CROSS