Provider Demographics
NPI:1386974988
Name:WELLS-MANLANDRO, VICTORIA (MSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:WELLS-MANLANDRO
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-2523
Mailing Address - Country:US
Mailing Address - Phone:609-408-6565
Mailing Address - Fax:
Practice Address - Street 1:2301 NEW YORK AVENUE
Practice Address - Street 2:
Practice Address - City:NORTH WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-2523
Practice Address - Country:US
Practice Address - Phone:609-408-6565
Practice Address - Fax:609-886-0990
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00122200101YA0400X
NJ44SC006683001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)