| Doctor Name: | SUSAN WILDERMANN |
| NPI Number: | 1083890123 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MA, PD(MFT), LPC |
| License Number: | 37PC00357000 |
| Business Practice Address: | 512 Clinton Ave Belford, NJ - 077181217 |
| Business Phone Number: | 7328957009 |
| Business Fax Number: | 7327873268 |
| Mailing Address: | 512 Clinton Ave, BELFORD |
| State: | NJ |
| Postal Code: | 077181217 |
| Phone Number: | 7328957009 |
| Fax Number: | 7327873268 |
| NPI Enumeration Date: | 01/19/2008 |
| NPI Last Update Date: | 01/19/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 37PC00357000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |