Provider Demographics
NPI:1609192921
Name:PARTE-WILLBERGH, M KATHLEEN (MA)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:KATHLEEN
Last Name:PARTE-WILLBERGH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHLEEN
Other - Last Name:PARTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:208 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-3044
Mailing Address - Country:US
Mailing Address - Phone:732-612-3148
Mailing Address - Fax:
Practice Address - Street 1:2635 FOX LN
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-2416
Practice Address - Country:US
Practice Address - Phone:732-612-3148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00173000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional