Provider Demographics
NPI:1669767471
Name:WENNER, CAROL E (LCSW)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:E
Last Name:WENNER
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 1:612 PENNSYLVANIA AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-1224
Mailing Address - Country:US
Mailing Address - Phone:814-643-4939
Mailing Address - Fax:814-643-4903
Practice Address - Street 1:612 PENNSYLVANIA AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-1224
Practice Address - Country:US
Practice Address - Phone:814-643-4939
Practice Address - Fax:814-643-4903
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health