Provider Demographics
NPI:1750043493
Name:TEJEDA CASTILLO, WENDY ELIZABETH (MASTER MENTAL HEALTH)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:ELIZABETH
Last Name:TEJEDA CASTILLO
Suffix:
Gender:F
Credentials:MASTER MENTAL HEALTH
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:E
Other - Last Name:ORTIZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTER MENTAL HEALTH
Mailing Address - Street 1:1623 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1209
Mailing Address - Country:US
Mailing Address - Phone:718-954-3800
Mailing Address - Fax:
Practice Address - Street 1:1623 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1209
Practice Address - Country:US
Practice Address - Phone:718-954-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013697-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health