Provider Demographics
NPI:1295378073
Name:WENGERTSMAN, EMILY JEAN (MS, LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JEAN
Last Name:WENGERTSMAN
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HERSCHEL AVE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-1717
Mailing Address - Country:US
Mailing Address - Phone:203-518-0502
Mailing Address - Fax:
Practice Address - Street 1:17 ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418-1840
Practice Address - Country:US
Practice Address - Phone:203-962-6589
Practice Address - Fax:475-777-5909
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional