Provider Demographics
NPI:1902447303
Name:ROSA, ALISON (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ALISON
Middle Name:
Last Name:ROSA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 JUDD HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-2919
Mailing Address - Country:US
Mailing Address - Phone:203-565-2440
Mailing Address - Fax:
Practice Address - Street 1:62 CARTER ROAD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757
Practice Address - Country:US
Practice Address - Phone:860-927-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT58.0105391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical