MEDICARE: MRS. WANDA THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor		NJ

General Provider Information

NPI Number	:	1073473872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WANDA THOMAS

Provider Business Mailing Address
First Line	:	149 MARINA DR APT B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-6147
Country	:	US
Telephone Number	:	732-900-7362
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 MARINA DR APT B
Second Line	:
City	:	EDISON
State	:	NJ
Zip	:	08817-6147
Country	:	US
Telephone Number	:	732-900-7362
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2025
Last Update Date	:	11/13/2025

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Directions to “ MRS. WANDA THOMAS ” Practice Location

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