Healthcare Provider Details

I. General information

NPI: 1518032192
Provider Name (Legal Business Name): MONA WELLER BIRK PHD, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MONA LOIS WELLER

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 08/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HOPKINSON CT
BASKING RIDGE NJ
07920-2982
US

IV. Provider business mailing address

32 HOPKINSON CT
BASKING RIDGE NJ
07920-2982
US

V. Phone/Fax

Practice location:
  • Phone: 908-306-0774
  • Fax:
Mailing address:
  • Phone: 908-306-0774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number26NC04510500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100409300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number35S100409300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35S100409300
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number35S100409300
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number35S100409300
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number35S100409300
License Number StateNJ
# 8
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number35S100409300
License Number StateNJ
# 9
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SW00117700
License Number StateNJ
# 10
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37F100122400
License Number StateNJ
# 11
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number26NR04510500
License Number StateNJ
# 12
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NR04510500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: