Provider Demographics
NPI:1770250904
Name:WALKER, WENDY WEAR
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:WEAR
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:WALKER
Other - Last Name:CLEARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:26 ARCHIBALD WAY APT SUITE
Mailing Address - Street 2:
Mailing Address - City:SAG HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11963-3437
Mailing Address - Country:US
Mailing Address - Phone:917-929-6448
Mailing Address - Fax:
Practice Address - Street 1:26 ARCHIBALD WAY APT SUITE
Practice Address - Street 2:
Practice Address - City:SAG HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11963-3437
Practice Address - Country:US
Practice Address - Phone:917-929-6448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical