Provider Demographics
NPI:1497301279
Name:WENDLAND, VICTORIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:WENDLAND
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 1:62 CARTER ROAD PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-0607
Mailing Address - Country:US
Mailing Address - Phone:860-927-3772
Mailing Address - Fax:860-927-1840
Practice Address - Street 1:62 CARTER ROAD
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757
Practice Address - Country:US
Practice Address - Phone:860-927-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106891041C0700X
CT0106891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical