Provider Demographics
NPI:1669299806
Name:WAX, ESTHER
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:WAX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 WILLIAMSBURG LN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1477
Mailing Address - Country:US
Mailing Address - Phone:732-575-4976
Mailing Address - Fax:
Practice Address - Street 1:206 WILLIAMSBURG LN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1477
Practice Address - Country:US
Practice Address - Phone:732-575-4976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty