Provider Demographics
NPI:1497819783
Name:BOSTONIAN, ROSANNE A (PHD)
Entity Type:Individual
Prefix:
First Name:ROSANNE
Middle Name:A
Last Name:BOSTONIAN
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 1:24 CARTERET ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1304
Mailing Address - Country:US
Mailing Address - Phone:973-783-4817
Mailing Address - Fax:973-660-0411
Practice Address - Street 1:205 RIDGEDALE AVE
Practice Address - Street 2:
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1349
Practice Address - Country:US
Practice Address - Phone:973-660-0377
Practice Address - Fax:973-660-0411
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist