Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 001836 | CT |
NPI | 1003329756 |
---|---|
Provider Name | Joann Rotar |
First Address | Waterbury, CT 06704-6102 |
Second Address | New Haven, CT 06515-1728 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2017 |
Last Update Date | 15/11/2017 |