Provider Demographics
NPI:1174502363
Name:ROSKIE, JACQUELINE M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:M
Last Name:ROSKIE
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:PO BOX 672
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-0672
Mailing Address - Country:US
Mailing Address - Phone:908-227-3681
Mailing Address - Fax:908-876-4980
Practice Address - Street 1:59 EAST MILL ROAD
Practice Address - Street 2:BLDG 2 SUITE 2 - 202
Practice Address - City:LONG VALLEY
Practice Address - State:NJ
Practice Address - Zip Code:07853
Practice Address - Country:US
Practice Address - Phone:908-227-3681
Practice Address - Fax:908-876-4980
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051550001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJRO 056272Medicare ID - Type Unspecified