Healthcare Provider Details

I. General information

NPI: 1891163192
Provider Name (Legal Business Name): WENDY LANDRIAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 BALTIMORE PIKE STE 250
SPRINGFIELD PA
19064-3974
US

IV. Provider business mailing address

3819 CHESTNUT ST GARDEN LEVEL
PHILADELPHIA PA
19104-3171
US

V. Phone/Fax

Practice location:
  • Phone: 610-544-2110
  • Fax: 610-604-9510
Mailing address:
  • Phone: 215-387-3223
  • Fax: 215-387-3203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW021580
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW125589
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: