Healthcare Provider Details

I. General information

NPI: 1609284538
Provider Name (Legal Business Name): WENDY ZAGHA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 SUMMERFIELD AVE
ASBURY PARK NJ
07712-6921
US

IV. Provider business mailing address

178 WHALEPOND RD
OAKHURST NJ
07755-1352
US

V. Phone/Fax

Practice location:
  • Phone: 732-774-6886
  • Fax:
Mailing address:
  • Phone: 732-616-1086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05592100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: