=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447397617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY NEVILLE JONES LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 S BROADWAY
-----------------------------------------------------
City | TARRYTOWN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10591-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-333-0387
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 320 S MOUNTAIN RD
-----------------------------------------------------
City | NEW CITY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10956-4518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-638-6990
-----------------------------------------------------
Fax | 845-639-0352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R040680-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------