Provider Demographics
NPI:1538281613
Name:PANKEN, WENDY J (LCSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:J
Last Name:PANKEN
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 1:205 W END AVE APT 22H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4814
Mailing Address - Country:US
Mailing Address - Phone:212-501-9330
Mailing Address - Fax:
Practice Address - Street 1:205 W END AVE APT 22H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4814
Practice Address - Country:US
Practice Address - Phone:212-501-9330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#R304531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN72111Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER