Provider Demographics
NPI:1538106695
Name:WENZEL, ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:WENZEL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 249TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-1623
Mailing Address - Country:US
Mailing Address - Phone:718-640-8404
Mailing Address - Fax:
Practice Address - Street 1:17900 LINDEN BLVD
Practice Address - Street 2:SOCIAL WORK
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11425-0001
Practice Address - Country:US
Practice Address - Phone:718-526-1000
Practice Address - Fax:718-298-8515
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052904-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical