Provider Demographics
NPI:1659520401
Name:CHAUNCEY, WENDY LYN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LYN
Last Name:CHAUNCEY
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 1:23 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691
Mailing Address - Country:US
Mailing Address - Phone:609-575-1316
Mailing Address - Fax:609-208-1750
Practice Address - Street 1:23 NORTH ST
Practice Address - Street 2:
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691
Practice Address - Country:US
Practice Address - Phone:609-575-1316
Practice Address - Fax:609-208-1750
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC00661900103TP2701X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0385433Medicaid
NJ0169528Medicaid