Provider Demographics
NPI:1528448321
Name:QUEZADA, WANDA Y (ED D)
Entity type:Individual
Prefix:DR
First Name:WANDA
Middle Name:Y
Last Name:QUEZADA
Suffix:
Gender:F
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 GEORGE STREET
Mailing Address - Street 2:SUITE 4 #307
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3457
Mailing Address - Country:US
Mailing Address - Phone:908-358-5068
Mailing Address - Fax:908-312-5076
Practice Address - Street 1:322 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:732-202-5406
Practice Address - Fax:732-543-0602
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
NJ101YA0400X, 101Y00000X, 101YM0800X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ937923OtherBCBSNJ
CALPCC15042OtherLPCC
PAPC015328OtherLPC
FLTPMC3811OtherLMHC
NJ601288646OtherUNITED HEALTHCARE