Provider Demographics
NPI:1861576506
Name:ROSNER, BLANCHE (DSW)
Entity type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:
Last Name:ROSNER
Suffix:
Gender:F
Credentials:DSW
Other - Prefix:DR
Other - First Name:BLANCHE
Other - Middle Name:
Other - Last Name:ROSNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW
Mailing Address - Street 1:415 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-3508
Mailing Address - Country:US
Mailing Address - Phone:203-329-1578
Mailing Address - Fax:203-329-0514
Practice Address - Street 1:415 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-3508
Practice Address - Country:US
Practice Address - Phone:203-329-1578
Practice Address - Fax:203-329-0514
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0014971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT800002972Medicare ID - Type Unspecified