Provider Demographics
NPI:1255514048
Name:DUNN, WENDY MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIE
Last Name:DUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:DUMARS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4567 CROSSROADS PARK DR
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3589
Mailing Address - Country:US
Mailing Address - Phone:315-295-2100
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:270 RIVERSIDE DRIVE #201
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2741
Practice Address - Country:US
Practice Address - Phone:845-781-6061
Practice Address - Fax:607-648-8717
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0042731041C0700X
NY0811001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical