Provider Demographics
NPI:1508836347
Name:BEDENKO, WENDY ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:ELIZABETH
Last Name:BEDENKO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2749
Mailing Address - Country:US
Mailing Address - Phone:973-579-9990
Mailing Address - Fax:973-579-9930
Practice Address - Street 1:288 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2749
Practice Address - Country:US
Practice Address - Phone:973-940-9999
Practice Address - Fax:973-579-9930
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00410900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ076510Medicare ID - Type Unspecified