Provider Demographics
NPI:1437774387
Name:COLLINSON WAMBACK, BRIANNA F (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BRIANNA
Middle Name:F
Last Name:COLLINSON WAMBACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BRIANNA
Other - Middle Name:FAITH
Other - Last Name:COLLINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:87 STRUBLE RD
Mailing Address - Street 2:
Mailing Address - City:SANDYSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07826-5005
Mailing Address - Country:US
Mailing Address - Phone:908-601-7673
Mailing Address - Fax:
Practice Address - Street 1:87 STRUBLE RD
Practice Address - Street 2:
Practice Address - City:SANDYSTON
Practice Address - State:NJ
Practice Address - Zip Code:07826-5005
Practice Address - Country:US
Practice Address - Phone:908-601-7673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058672001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical