MEDICARE: EMILY MARISSA WOLLENBERG

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1902752553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MARISSA WOLLENBERG

Provider Business Mailing Address
First Line	:	312 BEECH ST
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-4021
Country	:	US
Telephone Number	:	201-779-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 BEECH ST
Second Line	:
City	:	TEANECK
State	:	NJ
Zip	:	07666-4021
Country	:	US
Telephone Number	:	201-779-7246
Fax Number	:

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

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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Directions to “ EMILY MARISSA WOLLENBERG ” Practice Location

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