Provider Demographics
NPI:1881742989
Name:OSTERHOUT, DAVID PAUL (LCSW,BCD)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PAUL
Last Name:OSTERHOUT
Suffix:
Gender:M
Credentials:LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LIPPINCOTT AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4766
Mailing Address - Country:US
Mailing Address - Phone:856-782-8383
Mailing Address - Fax:856-782-7679
Practice Address - Street 1:733 STATE HIGHWAY, #70, EAST ELMWOOD BUSINESS PARK
Practice Address - Street 2:SUITE 303
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053
Practice Address - Country:US
Practice Address - Phone:856-782-8383
Practice Address - Fax:856-782-7679
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00400000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222-613-985-000 MERIOtherTAXID MERIDIAN, CORP.