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General NPI Number Information
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NPI Number | 1437796075
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Entity Type | Individual
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Provider Name | ROBERT A WISSE LSW
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Gender | Male
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Dates
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Enumeration Date | 12/03/2019
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 53 ORCHARD ST
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City | CLIFTON
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State | NJ
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Zip | 07013-1832
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Country | US
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Telephone | 973-773-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 349 VALLEY BLVD
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City | WOOD RIDGE
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State | NJ
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Zip | 07075-1246
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Country | US
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Telephone | 975-557-7417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SL06511900
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License Number State | NJ
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