Provider Demographics
NPI:1295909679
Name:ROSELAND PSYCHOTHERAPY ASSOCIATES LLC
Entity type:Organization
Organization Name:ROSELAND PSYCHOTHERAPY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OVERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:973-226-1505
Mailing Address - Street 1:204 EAGLE ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07068-1723
Mailing Address - Country:US
Mailing Address - Phone:973-226-1505
Mailing Address - Fax:973-226-1506
Practice Address - Street 1:204 EAGLE ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROSELAND
Practice Address - State:NJ
Practice Address - Zip Code:07068-1723
Practice Address - Country:US
Practice Address - Phone:973-226-1505
Practice Address - Fax:973-226-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS103685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty