Provider Demographics
NPI:1205944626
Name:MUCHNICK, WENDY RUTH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:RUTH
Last Name:MUCHNICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 GROVE AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2322
Mailing Address - Country:US
Mailing Address - Phone:516-569-7805
Mailing Address - Fax:
Practice Address - Street 1:123 GROVE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2322
Practice Address - Country:US
Practice Address - Phone:516-569-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0349631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY096041000OtherMAGELLEN
NY5344693OtherAETNA
NY02033810Medicaid
NY3101939OtherGHI
NY096041000OtherMAGELLEN