Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 4656 | NJ |
NPI | 1013285808 |
---|---|
Provider Name | Dr. Danielle Aimee Weber Wiesen |
First Address | Scotch Plains, NJ 07076-2629 |
Second Address | Scotch Plains, NJ 07076-2629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2011 |
Last Update Date | 07/12/2011 |