Provider Demographics
NPI:1225625460
Name:HORNICK, WENDY M (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:M
Last Name:HORNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:QUOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11959-0435
Mailing Address - Country:US
Mailing Address - Phone:631-653-9374
Mailing Address - Fax:
Practice Address - Street 1:10 HEATHERWOOD LANE
Practice Address - Street 2:
Practice Address - City:QUOGUE
Practice Address - State:NY
Practice Address - Zip Code:11959
Practice Address - Country:US
Practice Address - Phone:917-608-2269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0836151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty