Provider Demographics
NPI:1407068976
Name:OSOFSKY, MIRIAM RACHEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:RACHEL
Last Name:OSOFSKY
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 1:2 WOODMORE DR
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03755-1321
Mailing Address - Country:US
Mailing Address - Phone:603-643-1664
Mailing Address - Fax:
Practice Address - Street 1:367 STATE ROUTE 120
Practice Address - Street 2:SUITE B-8
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1430
Practice Address - Country:US
Practice Address - Phone:603-443-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0608378Y0NH02Medicare UPIN