1568684876 NPI number — MS. NANCY LYNN WENDER LCSW

Table of content: MS. NANCY LYNN WENDER LCSW (NPI 1568684876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568684876 NPI number — MS. NANCY LYNN WENDER LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WENDER
Provider First Name:
NANCY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568684876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
145 HUDSON ST
Provider Second Line Business Mailing Address:
SUITE 6B
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10013-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-638-1701
Provider Business Mailing Address Fax Number:
646-638-1703

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 HUDSON ST
Provider Second Line Business Practice Location Address:
SUITE 6B
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10013-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-638-1701
Provider Business Practice Location Address Fax Number:
646-638-1703
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  R054487-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P2026160 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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