Provider Demographics
NPI:1932295417
Name:COSGROVE, DOREEN (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:DOREEN
Middle Name:
Last Name:COSGROVE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:A34 HARVEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662
Mailing Address - Country:US
Mailing Address - Phone:201-803-9861
Mailing Address - Fax:201-843-3502
Practice Address - Street 1:55 OLD NYACK TURNPIKE
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954
Practice Address - Country:US
Practice Address - Phone:201-803-9861
Practice Address - Fax:201-843-3502
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist