Provider Demographics
NPI:1962550426
Name:RUSAK, ROSALIE J (EDS IN MFT)
Entity type:Individual
Prefix:MS
First Name:ROSALIE
Middle Name:J
Last Name:RUSAK
Suffix:
Gender:F
Credentials:EDS IN MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DENTREE PATH
Mailing Address - Street 2:
Mailing Address - City:EAST HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11937-1116
Mailing Address - Country:US
Mailing Address - Phone:631-324-3117
Mailing Address - Fax:631-324-3117
Practice Address - Street 1:4 DENTREE PATH
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-1116
Practice Address - Country:US
Practice Address - Phone:631-324-3117
Practice Address - Fax:631-324-3117
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000219-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist