Provider Demographics
NPI:1740367150
Name:VANVOLKENBURGH, GWENDOLYN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:
Last Name:VANVOLKENBURGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:GWENDOLYN
Other - Middle Name:
Other - Last Name:VANVOLKENBURGH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:60 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-3129
Mailing Address - Country:US
Mailing Address - Phone:908-752-8121
Mailing Address - Fax:
Practice Address - Street 1:60 DALE DR
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3129
Practice Address - Country:US
Practice Address - Phone:908-752-8121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05285800101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health