Provider Demographics
NPI:1033603568
Name:WEGMANN, TAYLOR (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:WEGMANN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CHANTICLEER
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-4831
Mailing Address - Country:US
Mailing Address - Phone:609-922-3803
Mailing Address - Fax:
Practice Address - Street 1:39 E MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2154
Practice Address - Country:US
Practice Address - Phone:856-409-0610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0218151041C0700X
NJ44SC057909001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical