Individual
DOV WAIDENBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
60 CANARY DR, LAKEWOOD, NJ 08701-5455
(732) 942-4669
Mailing address
60 CANARY DR, LAKEWOOD, NJ 08701-5455
(732) 942-4669
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00577400
NJ
Other
Enumeration date
06/14/2018
Last updated
06/14/2018
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