Provider Demographics
NPI:1285630616
Name:OOSTING, ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:
Last Name:OOSTING
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 1:5 DURYEA RD
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1901
Mailing Address - Country:US
Mailing Address - Phone:973-746-8603
Mailing Address - Fax:973-746-8603
Practice Address - Street 1:5 DURYEA RD
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1901
Practice Address - Country:US
Practice Address - Phone:973-746-8603
Practice Address - Fax:973-746-8603
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2149103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOO608188Medicare ID - Type Unspecified