Provider Demographics
NPI:1144199589
Name:WELLS, GWENDOLYN DENISE (CPRS)
Entity type:Individual
Prefix:MISS
First Name:GWENDOLYN
Middle Name:DENISE
Last Name:WELLS
Suffix:
Gender:F
Credentials:CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 VAN HOUTEN ST STE 4
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07505-1060
Mailing Address - Country:US
Mailing Address - Phone:862-407-2225
Mailing Address - Fax:
Practice Address - Street 1:34 VAN HOUTEN ST STE 4
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07505-1060
Practice Address - Country:US
Practice Address - Phone:862-407-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ51030101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty