Provider Demographics
NPI:1043384019
Name:WEDECK, YAEL (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:YAEL
Middle Name:
Last Name:WEDECK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SOUTH PKWY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014
Mailing Address - Country:US
Mailing Address - Phone:973-470-0640
Mailing Address - Fax:
Practice Address - Street 1:661 FRANKLIN AVE FL 2
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1209
Practice Address - Country:US
Practice Address - Phone:908-627-1937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046314001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ698293Medicare ID - Type Unspecified