Provider Demographics
NPI:1134573355
Name:LAWRENCE J. WENZ, PSY.D., P.C.
Entity type:Organization
Organization Name:LAWRENCE J. WENZ, PSY.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:WENZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:845-782-0872
Mailing Address - Street 1:151 CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3644
Mailing Address - Country:US
Mailing Address - Phone:845-782-0872
Mailing Address - Fax:845-782-2586
Practice Address - Street 1:151 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3644
Practice Address - Country:US
Practice Address - Phone:845-782-0872
Practice Address - Fax:845-782-2586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008688-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty