Healthcare Provider Details

I. General information

NPI: 1619338480
Provider Name (Legal Business Name): KATHRYN WESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 KLEMM AVE
GLOUCESTER CITY NJ
08030-1627
US

IV. Provider business mailing address

770 WOODLANE RD
WESTAMPTON NJ
08060-3804
US

V. Phone/Fax

Practice location:
  • Phone: 856-282-5566
  • Fax: 856-396-9917
Mailing address:
  • Phone: 609-267-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL0418300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: