Siomara Wedderburn, LSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

44SL06845400 Issued in NJ

Practice address

42 Delsea Dr S
Glassboro, NJ 08028-2621

Phone

(844) 422-3632

Fax

(856) 881-5508

NPI assigned

Apr 3, 2025

Last updated

Apr 3, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1743638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1093519571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42 DELSEA DR S",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282621",
            "telephone_number": "844-422-3632",
            "fax_number": "856-881-5508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "42 DELSEA DR S",
            "city": "GLASSBORO",
            "state": "NJ",
            "postal_code": "080282621",
            "telephone_number": "844-422-3632",
            "fax_number": "856-881-5508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDDERBURN",
        "first_name": "SIOMARA",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-03",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "44SL06845400",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SL06845400",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charita Angela Walker
• Alice Walls, PT
• John Watson, DPM
• Quataijah S Watson
• Susan Weaver
• Chuck Whedon, ATC, CSCS
• John Ezra Williams
• Valerie Ann Willis, LPC
• Malaysia Witherspoon
• David Allan Wolf, RPH

• Mental Health Counselor in Glassboro, NJ
• Providers in Glassboro, NJ by specialty
• Mental Health Counselor in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.