Provider Demographics
NPI:1629267737
Name:KRAUS, WENDY MERYL (LMSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MERYL
Last Name:KRAUS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-0012
Mailing Address - Country:US
Mailing Address - Phone:646-279-4371
Mailing Address - Fax:
Practice Address - Street 1:853 BROADWAY STE 1401
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4716
Practice Address - Country:US
Practice Address - Phone:646-279-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY075487-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical