1417475211 NPI number — ROSEMARY GALLAGHER OSTROSKY LCSW

Table of content: ROSEMARY GALLAGHER OSTROSKY LCSW (NPI 1417475211)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417475211 NPI number — ROSEMARY GALLAGHER OSTROSKY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER OSTROSKY
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417475211
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PROFESSIONAL DEVELOPMENTAL SERVICES INC
Provider Second Line Business Mailing Address:
5 PFOUT STREET
Provider Business Mailing Address City Name:
WILKES BARRE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-829-0795
Provider Business Mailing Address Fax Number:
570-829-2294

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 PFOUT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILKES BARRE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-829-0795
Provider Business Practice Location Address Fax Number:
570-829-2294
Provider Enumeration Date:
09/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CW016870 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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