MEDICARE: DR. THOMAS J ROSTAFINSKI PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	713164	IL

General Provider Information

NPI Number	:	1508859521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS J ROSTAFINSKI PHD

Provider Business Mailing Address
First Line	:	7627 LAKE ST STE 215
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1878
Country	:	US
Telephone Number	:	708-848-1611
Fax Number	:	708-848-1436

Provider Business Practice Location Address
First Line	:	7627 LAKE ST STE 215
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-1878
Country	:	US
Telephone Number	:	708-848-1611
Fax Number	:	708-848-1436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	01/30/2024

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