MEDICARE: GLEN DAVID WERNICK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	002981-01	NY

General Provider Information

NPI Number	:	1528771409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLEN DAVID WERNICK

Provider Business Mailing Address
First Line	:	1422 NELSON AVE APT 2F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-1735
Country	:	US
Telephone Number	:	332-257-8821
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 NELSON AVE APT 2F
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10452-1735
Country	:	US
Telephone Number	:	332-257-8821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	01/05/2023

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Directions to “ GLEN DAVID WERNICK ” Practice Location

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