Healthcare Provider Details

I. General information

NPI: 1023206653
Provider Name (Legal Business Name): WENDY F AITA PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 TANYARD ROAD SUITE C100
SEWELL NJ
08080
US

IV. Provider business mailing address

2250 CHAPEL AVE W STE 100
CHERRY HILL NJ
08002-2051
US

V. Phone/Fax

Practice location:
  • Phone: 856-932-7476
  • Fax: 856-566-6320
Mailing address:
  • Phone: 856-482-9000
  • Fax: 856-482-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35SI00306900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: