Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 35S100409300 | NJ |
N | 103T00000X | Psychologist | 35S100409300 | NJ |
N | 103TA0700X | Adult Development & Aging Psychologist | 35S100409300 | NJ |
N | 103G00000X | Clinical Psychologist | 35S100409300 | NJ |
N | 103TC0700X | Clinical Psychologist | 35S100409300 | NJ |
N | 103TC1900X | Counseling Psychologist | 35S100409300 | NJ |
N | 103TF0000X | Family Psychologist | 35S100409300 | NJ |
N | 103TM1800X | Intellectual & Developmental Disabilities | 35S100409300 | NJ |
N | 103TR0400X | Rehabilitation Psychologist | 35S100409300 | NJ |
N | 104100000X | Social Worker | 44SW00117700 | NJ |
NPI | 1518032192 |
---|---|
Provider Name | Dr. Mona Weller Birk |
First Address | Basking Ridge, NJ 07920-2982 |
Second Address | Basking Ridge, NJ 07920-2982 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 24/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0023850 | (05) | NJ |
016408DBG | MEDICARE ID-CNS-INHEALTH (01) | NJ |
076509APU | MEDICARE ID-PHD-ROSSI (01) | NJ |
076509DBG | MEDICARE ID-PHD-INHEALTH (01) | NJ |
143411APU | MEDICARE ID-CNS-ROSSI (01) | NJ |
4144007 | (05) | NJ |
S62617 | (02) | NJ |