Provider Demographics
NPI:1902408792
Name:WOLTHER, VICTORIA E (LSW)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:E
Last Name:WOLTHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 PALMER TER
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-1418
Mailing Address - Country:US
Mailing Address - Phone:201-388-1387
Mailing Address - Fax:
Practice Address - Street 1:14-25 PLAZA RD STE S22
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-3591
Practice Address - Country:US
Practice Address - Phone:201-388-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06058700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker