Provider Demographics
NPI:1508062290
Name:GOLDWERT, SUZANNE WELLS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:WELLS
Last Name:GOLDWERT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 BOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-8709
Mailing Address - Country:US
Mailing Address - Phone:732-822-9073
Mailing Address - Fax:
Practice Address - Street 1:1 SHIMER BLVD
Practice Address - Street 2:1 SHIMER BLVD
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-3723
Practice Address - Country:US
Practice Address - Phone:732-822-9073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00280700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional