Provider Demographics
NPI:1558485359
Name:WELLSPRINGS, A HEALTH SERVICES PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WELLSPRINGS, A HEALTH SERVICES PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:SIGMUND
Authorized Official - Last Name:ALBAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-596-1652
Mailing Address - Street 1:508 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4802
Mailing Address - Country:US
Mailing Address - Phone:856-596-1652
Mailing Address - Fax:856-596-7797
Practice Address - Street 1:508 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4802
Practice Address - Country:US
Practice Address - Phone:856-596-1652
Practice Address - Fax:856-596-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI-01282103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449768Medicare ID - Type Unspecified