Provider Demographics
NPI:1992321129
Name:WURSTER, MORGAN LEIGH
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:LEIGH
Last Name:WURSTER
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 1:3826 PARK AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2565
Mailing Address - Country:US
Mailing Address - Phone:848-247-6235
Mailing Address - Fax:
Practice Address - Street 1:3826 PARK AVE STE 102
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2565
Practice Address - Country:US
Practice Address - Phone:848-247-6235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician