Provider Demographics
NPI:1083822258
Name:NELSON, WENDY ELIZABETH (MENTAL HEALTH THERAP)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ELIZABETH
Last Name:NELSON
Suffix:
Gender:F
Credentials:MENTAL HEALTH THERAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 79TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-6470
Mailing Address - Country:US
Mailing Address - Phone:212-721-0336
Mailing Address - Fax:
Practice Address - Street 1:124 W 79TH ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6470
Practice Address - Country:US
Practice Address - Phone:212-721-0336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002420101YM0800X
NY000401106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002420OtherMENTAL HEALTH THERAPIST
NY000401OtherMARRIAGE AND FAMILY THERA