Provider Demographics
NPI:1114065661
Name:WELLES, BRENDA ARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:ARLENE
Last Name:WELLES
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 1:26 GOLDFINCH DR
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-3008
Mailing Address - Country:US
Mailing Address - Phone:908-850-8068
Mailing Address - Fax:
Practice Address - Street 1:135 COLUMBIA TPKE
Practice Address - Street 2:SUITE 303
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-2104
Practice Address - Country:US
Practice Address - Phone:973-514-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC004355001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5616302OtherAETNA PROVIDER ID NUMBER
NJ837754Medicare ID - Type Unspecified