Provider Demographics
NPI:1700195070
Name:ORELLANA, WENDY VANESSA (LPC LICENSED PROFESS)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:VANESSA
Last Name:ORELLANA
Suffix:
Gender:F
Credentials:LPC LICENSED PROFESS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:473 BROADWAY SUITE 202
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002
Mailing Address - Country:US
Mailing Address - Phone:862-324-6739
Mailing Address - Fax:
Practice Address - Street 1:1011 AVENUE C #123
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002
Practice Address - Country:US
Practice Address - Phone:862-324-6739
Practice Address - Fax:201-547-2026
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NJ37PC00521600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health