Provider Demographics
NPI:1316337116
Name:WESLEY, JUDETH F (RN, LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:JUDETH
Middle Name:F
Last Name:WESLEY
Suffix:
Gender:F
Credentials:RN, LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CEDAR KNOLLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07927-0123
Mailing Address - Country:US
Mailing Address - Phone:973-943-0805
Mailing Address - Fax:
Practice Address - Street 1:502 SPRING HOLLOW DR
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-2405
Practice Address - Country:US
Practice Address - Phone:973-943-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-31
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00122300101YA0400X
NJ44SC054025001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)