Provider Demographics
NPI:1952550592
Name:BEALE, WENDY KAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:KAY
Last Name:BEALE
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 1:770 JAMES ST STE 215
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2644
Mailing Address - Country:US
Mailing Address - Phone:315-422-0671
Mailing Address - Fax:315-422-2734
Practice Address - Street 1:770 JAMES ST STE 215
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2644
Practice Address - Country:US
Practice Address - Phone:315-422-0671
Practice Address - Fax:315-422-2734
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17465101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)