Healthcare Provider Details

I. General information

NPI: 1770634545
Provider Name (Legal Business Name): GLENN L WOJTOWICZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 FRIES MILL RD BLDG 2
TURNERSVILLE NJ
08012-2016
US

IV. Provider business mailing address

527 FOREST EDGE
DEPTFORD NJ
08096-2952
US

V. Phone/Fax

Practice location:
  • Phone: 856-270-2415
  • Fax: 856-270-2403
Mailing address:
  • Phone: 856-686-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05172400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: