Provider Demographics
NPI:1497899462
Name:POVERMAN, ROSEMARIE D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:D
Last Name:POVERMAN
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 1:28 UNION AVENUE
Mailing Address - Street 2:PO BOX 95
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-1477
Mailing Address - Fax:732-223-3530
Practice Address - Street 1:28 UNION AVE
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3630
Practice Address - Country:US
Practice Address - Phone:732-223-1477
Practice Address - Fax:732-223-3530
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000748001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ640626Medicare ID - Type UnspecifiedSOLE PROVIDER