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General NPI Number Information
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NPI Number | 1508859521
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Entity Type | Individual
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Provider Name | THOMAS J ROSTAFINSKI PHD
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Gender | Male
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 7627 LAKE ST STE 215
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City | RIVER FOREST
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State | IL
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Zip | 60305-1878
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Country | US
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Telephone | 708-848-1611
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Fax | 708-848-1436
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Provider Business Mailing Address
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Address Line | 7627 LAKE ST STE 215
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City | RIVER FOREST
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State | IL
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Zip | 60305-1878
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Country | US
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Telephone | 708-848-1611
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Fax | 708-848-1436
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 713164
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License Number State | IL
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