Provider Demographics
NPI:1558631291
Name:WEINBERG ROSENBAUM, JUDITH A
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WEINBERG ROSENBAUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 PENNINGTON AVE # A
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-3405
Mailing Address - Country:US
Mailing Address - Phone:973-563-3313
Mailing Address - Fax:
Practice Address - Street 1:323 PENNINGTON AVE # A
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-3405
Practice Address - Country:US
Practice Address - Phone:973-563-3313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05637000104100000X
NJ37LC00160500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker