Provider Demographics
NPI:1750835864
Name:ALBINO-WIMBUSH, AIDA (LCADC)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:
Last Name:ALBINO-WIMBUSH
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2118
Mailing Address - Country:US
Mailing Address - Phone:760-994-4990
Mailing Address - Fax:
Practice Address - Street 1:203 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08618-3432
Practice Address - Country:US
Practice Address - Phone:760-994-4990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
37LC00219800106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist