Wanda Rose Costanzo, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35SI00138100 Issued in NJ

Practice address

49 Grove Street
Suite C
Haddonfield, NJ 08033-1232

Phone

(856) 428-6640

Fax

(856) 428-9185

NPI assigned

Feb 28, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Dr. Wandz Costanzo Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1851429328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 GROVE STREET",
            "address_2": "SUITE C",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080331232",
            "telephone_number": "856-428-6640",
            "fax_number": "856-428-9185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 GROVE STREET",
            "address_2": "SUITE C",
            "city": "HADDONFIELD",
            "state": "NJ",
            "postal_code": "080331232",
            "telephone_number": "856-428-6640",
            "fax_number": "856-428-9185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSTANZO",
        "first_name": "WANDA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35SI00138100",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERI HEALTH",
            "identifier": "0825470000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE CHAMPUS",
            "identifier": "J0180078",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WANDZ",
            "last_name": "COSTANZO",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Cooper Medical Supply
• Cooper University Hospital
• David Michael Cordier, PH.D.
• Joseph M Costa
• Teresa Costantini, MSW, LCSW
• Melissa Cramutolo, LCSW
• Creative Process Wellness Center
• Richard John Crowell Jr., DPT
• Albert D'Angelantonio III, DPM
• Robert Mitchell Dalsey, M.D.

• All providers in Haddonfield, NJ
• Clinical Psychologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.