Provider Demographics
NPI:1376764399
Name:WEDIN, LOIS (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:
Last Name:WEDIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:599 WEST END AVE.
Mailing Address - Street 2:#1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-4001
Mailing Address - Country:US
Mailing Address - Phone:212-580-2268
Mailing Address - Fax:
Practice Address - Street 1:599 WEST END AVE.
Practice Address - Street 2:#1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-4001
Practice Address - Country:US
Practice Address - Phone:212-580-2268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0101301041C0700X
NYPR010130-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN44051Medicare UPIN