Provider Demographics
NPI:1982823530
Name:WOLOSH, MIRIAM SHERR (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:SHERR
Last Name:WOLOSH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5250
Mailing Address - Country:US
Mailing Address - Phone:973-540-9943
Mailing Address - Fax:973-326-1521
Practice Address - Street 1:66 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5250
Practice Address - Country:US
Practice Address - Phone:973-540-9943
Practice Address - Fax:973-326-1521
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3381103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist