MEDICARE: MRS. KATHLEEN MARIE OSTERTAG LPC

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	101YP2500X	Professional Counselor	37PC00149900	NJ

General Provider Information

NPI Number	:	1558314708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN MARIE OSTERTAG LPC

Provider Business Mailing Address
First Line	:	37 VICTORY PL
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-2232
Country	:	US
Telephone Number	:	732-651-2099
Fax Number	:

Provider Business Practice Location Address
First Line	:	3186 ROUTE 27
Second Line	:	SUITE 201
City	:	KENDALL PARK
State	:	NJ
Zip	:	08824-2232
Country	:	US
Telephone Number	:	732-651-2099
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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