Provider Demographics
NPI:1558683987
Name:WOHLGEMUTH, SUSAN NESTLER (LICENSED PROFESSIONA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:NESTLER
Last Name:WOHLGEMUTH
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:654 EAST JERSEY ST.
Mailing Address - Street 2:TRINITAS HOSPITAL
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07206
Mailing Address - Country:US
Mailing Address - Phone:908-994-7265
Mailing Address - Fax:908-994-7342
Practice Address - Street 1:654 EAST JERSEY ST.
Practice Address - Street 2:TRINITAS HOSPITAL
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07206
Practice Address - Country:US
Practice Address - Phone:908-994-7265
Practice Address - Fax:908-994-7342
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00360200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional