Provider Demographics
NPI:1891304622
Name:PROVEN-FAHY, ROSEMARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:PROVEN-FAHY
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 1:47 OZONE AVE
Mailing Address - Street 2:
Mailing Address - City:CEDAR GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:07009-2130
Mailing Address - Country:US
Mailing Address - Phone:973-768-6263
Mailing Address - Fax:
Practice Address - Street 1:3175 RT. 10 BUILDING C
Practice Address - Street 2:SUITE 700
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834
Practice Address - Country:US
Practice Address - Phone:862-200-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058397001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty