Provider Demographics
NPI:1952454944
Name:ROBERTSON, WAYNE DAVID (LCSW, LCADC)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:DAVID
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 PLEASANTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3917
Mailing Address - Country:US
Mailing Address - Phone:973-696-5974
Mailing Address - Fax:
Practice Address - Street 1:573 VALLEY RD STE 4 B
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3552
Practice Address - Country:US
Practice Address - Phone:973-696-0058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ154101YA0400X
NJ15781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical