Provider Demographics
NPI:1952443228
Name:WEGEMAN, DENISE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:WEGEMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 HIGHWAY 35 STE 250
Mailing Address - Street 2:BROOK 35 PLAZA
Mailing Address - City:SEA GIRT
Mailing Address - State:NJ
Mailing Address - Zip Code:08750-1012
Mailing Address - Country:US
Mailing Address - Phone:732-359-0240
Mailing Address - Fax:
Practice Address - Street 1:2150 HIGHWAY 35 STE 250
Practice Address - Street 2:BROOK 35 PLAZA
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1012
Practice Address - Country:US
Practice Address - Phone:732-359-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052633001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical