Provider Demographics
NPI:1457406043
Name:JAYVANTI, WENDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:
Last Name:JAYVANTI
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 1:182 W LORENGO AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-4339
Mailing Address - Country:US
Mailing Address - Phone:720-273-0278
Mailing Address - Fax:757-965-9077
Practice Address - Street 1:182 W LORENGO AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23503-4339
Practice Address - Country:US
Practice Address - Phone:770-273-0278
Practice Address - Fax:747-965-9077
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO509458Medicare ID - Type Unspecified