MEDICARE: MRS. WENDY RUTH MUCHNICK LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	R034963	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	096041000	OTHER	NY	MAGELLEN
2	5344693	OTHER	NY	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3101939	OTHER	NY	GHI

General Provider Information

NPI Number	:	1205944626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. WENDY RUTH MUCHNICK LCSW

Provider Business Mailing Address
First Line	:	123 GROVE AVE
Second Line	:	SUITE 202
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2322
Country	:	US
Telephone Number	:	516-569-7805
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 GROVE AVE
Second Line	:	SUITE 202
City	:	CEDARHURST
State	:	NY
Zip	:	11516-2322
Country	:	US
Telephone Number	:	516-569-7805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2006
Last Update Date	:	08/04/2010

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