1669667754 NPI number — MS. BELINDA NELLIE WANDEL LCSW-R

Table of content: MS. BELINDA NELLIE WANDEL LCSW-R (NPI 1669667754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669667754 NPI number — MS. BELINDA NELLIE WANDEL LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WANDEL
Provider First Name:
BELINDA
Provider Middle Name:
NELLIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
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:
1669667754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5130 E MAIN STREET RD STE 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATAVIA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14020-3496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-344-1421
Provider Business Mailing Address Fax Number:
585-345-3080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 BATAVIA CITY CENTRE
Provider Second Line Business Practice Location Address:
BATAVIA COMMUNITY CARE CENTER
Provider Business Practice Location Address City Name:
BATAVIA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-344-4246
Provider Business Practice Location Address Fax Number:
585-344-4895
Provider Enumeration Date:
09/11/2007

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:  074312 , 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: 05333404 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5717300 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 12463317 . This is a "EXCELLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: J300490154 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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