Provider Demographics
NPI:1730551292
Name:WIELADEK, CHRISTINE I
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:WIELADEK
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 WISTERIA CT
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07418-1940
Mailing Address - Country:US
Mailing Address - Phone:609-276-3620
Mailing Address - Fax:
Practice Address - Street 1:1 INTERNATIONAL BLVD STE 400
Practice Address - Street 2:
Practice Address - City:MAHWAH
Practice Address - State:NJ
Practice Address - Zip Code:07495-0025
Practice Address - Country:US
Practice Address - Phone:201-512-8746
Practice Address - Fax:201-512-8810
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-11-9323103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst