Provider Demographics
NPI:1265874051
Name:WILSBACH, MARY K (MSW, LCSW, DRCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:WILSBACH
Suffix:
Gender:F
Credentials:MSW, LCSW, DRCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ATLANTIC AVE. SUITE 2200
Mailing Address - Street 2:HEALTHPLEX, ATLANTICARE AMBULATORY CARE SERVICES;
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401
Mailing Address - Country:US
Mailing Address - Phone:609-572-6043
Mailing Address - Fax:609-441-8154
Practice Address - Street 1:1401 ATLANTIC AVE.SUITE 2200
Practice Address - Street 2:HEALTHPLEX, ATLANTICARE AMBULATORY CARE SERVICES;
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401
Practice Address - Country:US
Practice Address - Phone:609-572-6043
Practice Address - Fax:609-441-8154
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC047203001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical