Provider Demographics
NPI:1124518238
Name:GOBER, WESLEY MICHAEL
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:MICHAEL
Last Name:GOBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 46TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-7168
Mailing Address - Country:US
Mailing Address - Phone:310-463-1782
Mailing Address - Fax:
Practice Address - Street 1:65 46TH ST APT 2
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-7168
Practice Address - Country:US
Practice Address - Phone:310-463-1782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)