Provider Demographics
NPI:1063512028
Name:CORTES, ROSA M (PHD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:CORTES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 NEW ROAD
Mailing Address - Street 2:SUITE F3
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221
Mailing Address - Country:US
Mailing Address - Phone:609-926-1165
Mailing Address - Fax:609-926-1228
Practice Address - Street 1:2106 NEW ROAD
Practice Address - Street 2:SUITE F3
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221
Practice Address - Country:US
Practice Address - Phone:609-926-1165
Practice Address - Fax:609-926-1228
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI00340100103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223766351OtherTAX ID
S39583Medicare UPIN
NJ223766351OtherTAX ID