Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 000935 | CT |
Y | 103T00000X | Psychologist | 000935 | CT |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 000935 | CT |
N | 103TH0100X | Health Service | 000935 | CT |
N | 103TM1800X | Intellectual & Developmental Disabilities | 000935 | CT |
N | 103TS0200X | School Psychologist | 000935 | CT |
NPI | 1346309507 |
---|---|
Provider Name | Dr. Wayne David Rosenfield |
First Address | Putnam, CT 06260-1836 |
Second Address | Putnam, CT 06260-1836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2006 |
Last Update Date | 19/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008036465 | (05) | CT |