Healthcare Provider Details

I. General information

NPI: 1710629514
Provider Name (Legal Business Name): WANDA STELLA MARAGNI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

762 ROUTE 202 # 206N
BRIDGEWATER NJ
08807-2551
US

IV. Provider business mailing address

762 ROUTE 202 # 206N
BRIDGEWATER NJ
08807-2551
US

V. Phone/Fax

Practice location:
  • Phone: 732-729-7091
  • Fax:
Mailing address:
  • Phone: 732-729-7091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05741500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: