Provider Demographics
NPI:1790294056
Name:ROSTIAC, EDWARD A (MA, LPC, NCC, CMC)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:A
Last Name:ROSTIAC
Suffix:
Gender:M
Credentials:MA, LPC, NCC, CMC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1805
Mailing Address - Country:US
Mailing Address - Phone:973-985-6317
Mailing Address - Fax:
Practice Address - Street 1:5 COLD HILL RD S
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-3230
Practice Address - Country:US
Practice Address - Phone:973-985-6317
Practice Address - Fax:973-985-6317
Is Sole Proprietor?:No
Enumeration Date:2017-09-29
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00559200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health