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General NPI Number Information
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NPI Number | 1962741553
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Entity Type | Organization
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Legal Business Name | WEDIKO CHILDREN'S SERVICES
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Dates
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Enumeration Date | 02/03/2013
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Last Update Date | 02/03/2013
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Provider Practice Location Address
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Address Line | 200 BLOOMINGDALE RD SECOND FLOOR
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City | WHITE PLAINS
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State | NY
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Zip | 10605-1514
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Country | US
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Telephone | 646-481-0184
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W 145TH ST
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City | NEW YORK
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State | NY
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Zip | 10031-5203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | KRISTEN RENSHAW
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Credential | LCSW
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Telephone | 646-481-0184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 079144
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 078168
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License Number State | NY
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