Provider Demographics
NPI:1700926441
Name:GAWTHNEY, ROSLYN LAVERNE (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:LAVERNE
Last Name:GAWTHNEY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 SOUTH AVE W
Mailing Address - Street 2:LEVEL III
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2686
Mailing Address - Country:US
Mailing Address - Phone:908-653-1801
Mailing Address - Fax:908-653-1806
Practice Address - Street 1:45 SOUTH AVE W
Practice Address - Street 2:LEVEL III
Practice Address - City:CRANFORD
Practice Address - State:NJ
Practice Address - Zip Code:07016-2686
Practice Address - Country:US
Practice Address - Phone:908-653-1801
Practice Address - Fax:908-653-1806
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
NJ1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP2126906OtherOXFORD INSURANCE
NJ1233OtherST. BARNABAS BHN
NJP2126906OtherOXFORD INSURANCE