| Doctor Name: | DR. MARY ANN DEROSA |
| NPI Number: | 1083737902 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PH.D. |
| License Number: | 35S100371200 |
| Business Practice Address: | 9 Virginia Rd Montville, NJ - 070459209 |
| Business Phone Number: | 9732999868 |
| Business Fax Number: | 9732999868 |
| Mailing Address: | 9 Virginia Rd, MONTVILLE |
| State: | NJ |
| Postal Code: | 070459209 |
| Phone Number: | 9732999868 |
| Fax Number: | 9732999868 |
| NPI Enumeration Date: | 04/07/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 35S100371200 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |