Provider Demographics
NPI:1023206653
Name:AITA, WENDY F (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:F
Last Name:AITA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 CHAPEL AVE W STE 100
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-2051
Mailing Address - Country:US
Mailing Address - Phone:856-482-9000
Mailing Address - Fax:856-482-1159
Practice Address - Street 1:1474 TANYARD ROAD
Practice Address - Street 2:SUITE C100
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080
Practice Address - Country:US
Practice Address - Phone:856-932-7476
Practice Address - Fax:856-566-6320
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00306900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5532001Medicaid
NJ462358OtherMEDICARE