Provider Demographics
NPI:1003904533
Name:OSGOODBY, NANCY ANNE (MSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANNE
Last Name:OSGOODBY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8010
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07653-8010
Mailing Address - Country:US
Mailing Address - Phone:201-226-1110
Mailing Address - Fax:201-226-1121
Practice Address - Street 1:64 S FARVIEW AVE
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2630
Practice Address - Country:US
Practice Address - Phone:201-226-1110
Practice Address - Fax:201-226-1121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC002949001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJOS738663Medicare PIN