Individual
MAGGIE WANIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
75 GROVE ST, APT 3, BLOOMFIELD, NJ 07003-5641
(917) 732-6942
Mailing address
75 GROVE ST, BLOOMFIELD, NJ 07003-5641
(917) 960-3555
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
Other
Enumeration date
06/11/2014
Last updated
10/24/2018
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