Healthcare Provider Details

I. General information

NPI: 1952023624
Provider Name (Legal Business Name): MICHELE GUDKNECHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 MAPLE AVE
WEST DEPTFORD NJ
08086-3041
US

IV. Provider business mailing address

173 MAPLE AVE
WEST DEPTFORD NJ
08086-3041
US

V. Phone/Fax

Practice location:
  • Phone: 856-360-0438
  • Fax:
Mailing address:
  • Phone: 856-360-0438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06476600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: