Provider Demographics
NPI:1861710709
Name:ROSENFIELD, COREY TRAVIS (MA, LPC, LADC)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:TRAVIS
Last Name:ROSENFIELD
Suffix:
Gender:M
Credentials:MA, LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06013-2216
Mailing Address - Country:US
Mailing Address - Phone:860-404-0833
Mailing Address - Fax:
Practice Address - Street 1:30 PECK RD
Practice Address - Street 2:SUITE 2104
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6123
Practice Address - Country:US
Practice Address - Phone:860-482-2613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002254101YP2500X
CT000986101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)