Provider Demographics
NPI:1851415251
Name:WEIDEMAN, WENDY (BA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:WEIDEMAN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 MAIN ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SCHOHARIE
Mailing Address - State:NY
Mailing Address - Zip Code:12157
Mailing Address - Country:US
Mailing Address - Phone:518-295-8336
Mailing Address - Fax:518-295-8724
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SCHOHARIE
Practice Address - State:NY
Practice Address - Zip Code:12157
Practice Address - Country:US
Practice Address - Phone:518-295-8336
Practice Address - Fax:518-295-8724
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00555784Medicaid