Healthcare Provider Details

I. General information

NPI: 1548366982
Provider Name (Legal Business Name): WENDY LYNN HERSH LMHC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 MAIN ST #1024
ROOSEVELT ISLAND NY
10044-0141
US

IV. Provider business mailing address

540 MAIN ST #1024
ROOSEVELT ISLAND NY
10044-0141
US

V. Phone/Fax

Practice location:
  • Phone: 212-752-1518
  • Fax: 212-752-1518
Mailing address:
  • Phone: 212-752-1518
  • Fax: 212-752-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number001332
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: