Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SC05498400 | NJ |
NPI | 1003181454 |
---|---|
Provider Name | Ms. Vicki L Weidman |
First Address | Perrineville, NJ 08535-1125 |
Second Address | Perrineville, NJ 08535-1125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2012 |
Last Update Date | 30/01/2015 |