Provider Demographics
NPI:1972978468
Name:LANDE-FORRESTER, WENDY (MSW)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:LANDE-FORRESTER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 6TH COURT
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410
Mailing Address - Country:US
Mailing Address - Phone:561-229-6472
Mailing Address - Fax:
Practice Address - Street 1:1639 FORUM PLACE
Practice Address - Street 2:SUITE 7
Practice Address - City:WEST PALM BEACH,
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-229-6472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health