Provider Demographics
NPI:1023668654
Name:KOSEN, HEATHER (MA,LPC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:KOSEN
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 LOTT RD
Mailing Address - Street 2:
Mailing Address - City:WANTAGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-3907
Mailing Address - Country:US
Mailing Address - Phone:973-725-9724
Mailing Address - Fax:
Practice Address - Street 1:74 LOTT RD
Practice Address - Street 2:
Practice Address - City:WANTAGE
Practice Address - State:NJ
Practice Address - Zip Code:07461-3907
Practice Address - Country:US
Practice Address - Phone:973-725-9724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00691100101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional