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General NPI Number Information
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NPI Number | 1174502363
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Entity Type | Individual
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Provider Name | JACQUELINE M ROSKIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/16/2006
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 59 EAST MILL ROAD BLDG 2 SUITE 2 - 202
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City | LONG VALLEY
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State | NJ
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Zip | 07853
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Country | US
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Telephone | 908-227-3681
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Fax | 908-876-4980
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Provider Business Mailing Address
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Address Line | PO BOX 672
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City | LONG VALLEY
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State | NJ
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Zip | 07853-0672
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Country | US
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Telephone | 908-227-3681
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Fax | 908-876-4980
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05155000
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License Number State | NJ
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