Provider Demographics
NPI:1588804421
Name:WENGER, JOHN MICHAEL II (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MICHAEL
Last Name:WENGER
Suffix:II
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 1:130 W KINGSBRIDGE RD RM 3B-20A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-3904
Mailing Address - Country:US
Mailing Address - Phone:718-584-9000
Mailing Address - Fax:
Practice Address - Street 1:130 W KINGSBRIDGE RD RM 3B-20A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-3904
Practice Address - Country:US
Practice Address - Phone:718-584-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-05
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0829401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical