Provider Demographics
NPI:1770634545
Name:WOJTOWICZ, GLENN L (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:L
Last Name:WOJTOWICZ
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 FOREST EDGE
Mailing Address - Street 2:
Mailing Address - City:DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2952
Mailing Address - Country:US
Mailing Address - Phone:856-686-0994
Mailing Address - Fax:
Practice Address - Street 1:151 FRIES MILL RD
Practice Address - Street 2:BLDG 2
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-2016
Practice Address - Country:US
Practice Address - Phone:856-270-2415
Practice Address - Fax:856-270-2403
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051724001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2353186000OtherAMERIHEALTH
NJ744810000OtherMAGELLAN