Provider Demographics
NPI:1821843681
Name:WRIGHT, JUDITH PAMELA (LSW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:PAMELA
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:3 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3111
Mailing Address - Country:US
Mailing Address - Phone:917-572-8161
Mailing Address - Fax:
Practice Address - Street 1:70 PARK ST STE 104
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2960
Practice Address - Country:US
Practice Address - Phone:862-234-5029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07093300101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health