Healthcare Provider Details

I. General information

NPI: 1174502363
Provider Name (Legal Business Name): JACQUELINE M ROSKIE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 EAST MILL ROAD BLDG 2 SUITE 2 - 202
LONG VALLEY NJ
07853
US

IV. Provider business mailing address

PO BOX 672
LONG VALLEY NJ
07853-0672
US

V. Phone/Fax

Practice location:
  • Phone: 908-227-3681
  • Fax: 908-876-4980
Mailing address:
  • Phone: 908-227-3681
  • Fax: 908-876-4980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05155000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: