Provider Demographics
NPI:1972669323
Name:WERNER, JOHN JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:WERNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1505
Mailing Address - Country:US
Mailing Address - Phone:631-757-2351
Mailing Address - Fax:
Practice Address - Street 1:2000 DEER PARK AVE
Practice Address - Street 2:BOX 326
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2701
Practice Address - Country:US
Practice Address - Phone:631-667-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008490103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00926036Medicaid
NY008490OtherLICENSE NUMBER