Provider Demographics
NPI:1790991248
Name:DAVENSON, WENDY H (LMFT, LADC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:H
Last Name:DAVENSON
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 CHURCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:SANDY HOOK
Mailing Address - State:CT
Mailing Address - Zip Code:06482-1110
Mailing Address - Country:US
Mailing Address - Phone:203-426-1997
Mailing Address - Fax:203-426-1997
Practice Address - Street 1:88 CHURCH HILL RD
Practice Address - Street 2:
Practice Address - City:SANDY HOOK
Practice Address - State:CT
Practice Address - Zip Code:06482-1110
Practice Address - Country:US
Practice Address - Phone:203-426-1997
Practice Address - Fax:203-426-1997
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000076101YA0400X
CT000591106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000591CT02OtherANTHEM BCBS