Healthcare Provider Details

I. General information

NPI: 1154648913
Provider Name (Legal Business Name): WENDY SUE JORGENSEN LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

358 VETERANS MEMORIAL HWY STE 10
COMMACK NY
11725-4326
US

IV. Provider business mailing address

12 REDWOOD LN
SOUTH SETAUKET NY
11720-1431
US

V. Phone/Fax

Practice location:
  • Phone: 516-900-2813
  • Fax:
Mailing address:
  • Phone: 516-900-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR046715-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: