Provider Demographics
NPI:1558631291
Name:WEINBERG ROSENBAUM, JUDITH A
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WEINBERG ROSENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ETHEL RD
Mailing Address - Street 2:SUITE 101B
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2838
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ETHEL RD
Practice Address - Street 2:SUITE 101B
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2838
Practice Address - Country:US
Practice Address - Phone:732-248-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00160500101YA0400X
NJ44SL05637000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker