Provider Demographics
NPI:1700113560
Name:WOLBERG, SALLY ROBERTA (LPC)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:ROBERTA
Last Name:WOLBERG
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2728
Mailing Address - Country:US
Mailing Address - Phone:732-549-6000
Mailing Address - Fax:
Practice Address - Street 1:224 MAIN ST
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2728
Practice Address - Country:US
Practice Address - Phone:732-549-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-14
Last Update Date:2009-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00061400101YA0400X
NJ37PC00120800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)