Provider Demographics
NPI:1841404555
Name:STAPEN, WENDY SCARLET (PHD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SCARLET
Last Name:STAPEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2830
Mailing Address - Country:US
Mailing Address - Phone:516-692-5803
Mailing Address - Fax:516-692-7607
Practice Address - Street 1:56 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2830
Practice Address - Country:US
Practice Address - Phone:516-692-5803
Practice Address - Fax:516-692-7607
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017094103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical