Provider Demographics
NPI:1790837003
Name:WENDT, FRITZ (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRITZ
Middle Name:
Last Name:WENDT
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 WOOD RD
Mailing Address - Street 2:APT MF
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-7249
Mailing Address - Country:US
Mailing Address - Phone:718-822-0279
Mailing Address - Fax:
Practice Address - Street 1:506 MALCOLM X BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037-1802
Practice Address - Country:US
Practice Address - Phone:212-939-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY061202282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY813840OtherPROVIDER NUMBER CHILD PSY