Individual
DR. WANDA ROSE COSTANZO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
49 GROVE STREET, SUITE C, HADDONFIELD, NJ 08033-1232
(856) 428-6640
(856) 428-9185
Mailing address
49 GROVE STREET, SUITE C, HADDONFIELD, NJ 08033-1232
(856) 428-6640
(856) 428-9185
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
35SI00138100
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0825470000
AMERI HEALTH
—
01
—
J0180078
TRICARE CHAMPUS
—
Enumeration date
02/28/2007
Last updated
07/08/2007
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