Provider Demographics
NPI:1740797786
Name:WIENER, MICHALI (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHALI
Middle Name:
Last Name:WIENER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MICHALI
Other - Middle Name:
Other - Last Name:FRIEDMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:14010 JEWEL AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-1654
Mailing Address - Country:US
Mailing Address - Phone:443-694-8484
Mailing Address - Fax:
Practice Address - Street 1:14737 70TH RD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-1719
Practice Address - Country:US
Practice Address - Phone:646-396-0674
Practice Address - Fax:646-396-0674
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0849481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical