Healthcare Provider Details

I. General information

NPI: 1982357893
Provider Name (Legal Business Name): MARTYNA WEGRZYNOWSKA MHC-LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2022
Last Update Date: 02/13/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 N BROADWAY STE C1
MASSAPEQUA NY
11758-2348
US

IV. Provider business mailing address

1444 5TH AVE
BAY SHORE NY
11706-4147
US

V. Phone/Fax

Practice location:
  • Phone: 631-606-6068
  • Fax:
Mailing address:
  • Phone: 631-647-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18-P120158-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: