Provider Demographics
NPI:1467521500
Name:HALLER, OSNA L (PHD)
Entity Type:Individual
Prefix:
First Name:OSNA
Middle Name:L
Last Name:HALLER
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 1:265 CEDAR LN
Mailing Address - Street 2:SUITE 2
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3444
Mailing Address - Country:US
Mailing Address - Phone:201-836-7419
Mailing Address - Fax:201-692-3658
Practice Address - Street 1:265 CEDAR LN
Practice Address - Street 2:SUITE 2
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3444
Practice Address - Country:US
Practice Address - Phone:201-836-7419
Practice Address - Fax:201-692-3658
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2093103T00000X
NY7767103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ636757Medicare ID - Type Unspecified