Healthcare Provider Details

I. General information

NPI: 1720034150
Provider Name (Legal Business Name): WENDY FLEMING LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

939 JOHNSON AVE
RONKONKOMA NY
11779-6066
US

IV. Provider business mailing address

49 CHARLES RD
EAST PATCHOGUE NY
11772-6227
US

V. Phone/Fax

Practice location:
  • Phone: 631-471-7242
  • Fax: 631-738-0427
Mailing address:
  • Phone: 631-471-7242
  • Fax: 631-738-0427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR015231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: