Healthcare Provider Details

I. General information

NPI: 1790719979
Provider Name (Legal Business Name): PATRICIA A WIPPICH MSW LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 DENVER RD
PARAMUS NJ
07652-3205
US

IV. Provider business mailing address

219 DENVER RD
PARAMUS NJ
07652-3205
US

V. Phone/Fax

Practice location:
  • Phone: 201-265-0589
  • Fax:
Mailing address:
  • Phone: 201-265-0589
  • Fax: 201-265-1989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC00187500
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier44768
Identifier TypeOTHER
Identifier State
Identifier IssuerUNITED BEHAVIORAL HEALTH
# 2
IdentifierP530
Identifier TypeOTHER
Identifier State
Identifier IssuerOXFORD HEALTHCARE
# 3
Identifier1271
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerST BARNABAS HEALTHCARE
# 4
Identifier1281
Identifier TypeOTHER
Identifier State
Identifier IssuerST BARNABAS EAP
# 5
Identifier169288
Identifier TypeOTHER
Identifier State
Identifier IssuerMHN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: