Active NPI
Susan Wildermann, MA, PD(MFT), LPC
- Professional Counselor
- Belford, NJ
National Provider Identifier
1083890123
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 37PC00357000
- Practice address
- 512 Clinton Ave
Belford, NJ 07718-1217 - Phone
- (732) 895-7009
- Fax
- (732) 787-3268
- NPI assigned
- Jan 19, 2008
- Last updated
- Jan 19, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 37PC00357000 | NJ | Primary |
Addresses
Primary practice location
512 Clinton Ave
Belford, NJ 07718-1217
Mailing address
512 Clinton Ave
Belford, NJ 07718-1217
Phone (732) 895-7009
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37PC00357000 | NJ | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1200700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200700800000",
"number": "1083890123",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "512 CLINTON AVE",
"city": "BELFORD",
"state": "NJ",
"postal_code": "077181217",
"telephone_number": "732-895-7009",
"fax_number": "732-787-3268"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "512 CLINTON AVE",
"city": "BELFORD",
"state": "NJ",
"postal_code": "077181217",
"telephone_number": "732-895-7009",
"fax_number": "732-787-3268"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDERMANN",
"first_name": "SUSAN",
"credential": "MA, PD(MFT), LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-01-19",
"last_updated": "2008-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NJ",
"license": "37PC00357000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Belford, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.