Provider Demographics
| NPI: | 1518032192 |
|---|---|
| Name: | BIRK, MONA WELLER (PHD, APN) |
| Entity type: | Individual |
| Prefix: | DR |
| First Name: | MONA |
| Middle Name: | WELLER |
| Last Name: | BIRK |
| Suffix: | |
| Gender: | F |
| Credentials: | PHD, APN |
| Other - Prefix: | |
| Other - First Name: | MONA |
| Other - Middle Name: | LOIS |
| Other - Last Name: | WELLER |
| Other - Suffix: | |
| Other - Last Name Type: | Former Name |
| Other - Credentials: | |
| Mailing Address - Street 1: | 32 HOPKINSON CT |
| Mailing Address - Street 2: | |
| Mailing Address - City: | BASKING RIDGE |
| Mailing Address - State: | NJ |
| Mailing Address - Zip Code: | 07920-2982 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 908-306-0774 |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 32 HOPKINSON CT |
| Practice Address - Street 2: | |
| Practice Address - City: | BASKING RIDGE |
| Practice Address - State: | NJ |
| Practice Address - Zip Code: | 07920-2982 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 908-306-0774 |
| Practice Address - Fax: | |
| Is Sole Proprietor?: | Yes |
| Enumeration Date: | 2006-11-21 |
| Last Update Date: | 2012-08-24 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| NJ | 35S100409300 | 103TA0700X, 103TC0700X, 103TC1900X, 103TF0000X, 103TM1800X, 103TR0400X, 103T00000X |
| NJ | 44SW00117700 | 104100000X |
| NJ | 37F100122400 | 106H00000X |
| NJ | 26NR04510500 | 163W00000X, 163WP0809X |
| NJ | 26NC04510500 | 364S00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization |
|---|---|---|---|---|
| Yes | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | |
| No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical |
| No | 103TC1900X | Behavioral Health & Social Service Providers | Psychologist | Counseling |
| No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family |
| No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities |
| No | 103TR0400X | Behavioral Health & Social Service Providers | Psychologist | Rehabilitation |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
| No | 163W00000X | Nursing Service Providers | Registered Nurse | |
| No | 163WP0809X | Nursing Service Providers | Registered Nurse | Psychiatric/Mental Health, Adult |
| No | 103T00000X | Behavioral Health & Social Service Providers | Psychologist |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| NJ | 016408DBG | Other | MEDICARE ID-CNS-INHEALTH |
| NJ | 076509DBG | Other | MEDICARE ID-PHD-INHEALTH |
| NJ | 076509APU | Other | MEDICARE ID-PHD-ROSSI |
| NJ | 4144007 | Medicaid | |
| NJ | 0023850 | Medicaid | |
| NJ | 143411APU | Other | MEDICARE ID-CNS-ROSSI |
| NJ | 076509DBG | Other | MEDICARE ID-PHD-INHEALTH |
| NJ | 143411APU | Other | MEDICARE ID-CNS-ROSSI |
