Provider Demographics
NPI:1750440293
Name:WECHSLER, LAURA R (BSW MSW DSW)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:R
Last Name:WECHSLER
Suffix:
Gender:F
Credentials:BSW MSW DSW
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:LAURA
Other - Last Name:WECHSLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:35 KINGS HIGHWAY E
Mailing Address - Street 2:S110B
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033
Mailing Address - Country:US
Mailing Address - Phone:856-428-0228
Mailing Address - Fax:856-428-6522
Practice Address - Street 1:35 KINGS HIGHWAY E
Practice Address - Street 2:S110B
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:856-428-0228
Practice Address - Fax:856-428-6522
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW006568L104100000X
NJ44SC003031001041C0700X
NJ37F10014B200106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ37F10014B200OtherMARRIAGE & FAMILY THERAPY
NJ44SC00303100OtherCLINICAL SO WK LICENSE
PASW006568LOtherSO WKER
NJ37F10014B200OtherMARRIAGE & FAMILY THERAPY