MEDICARE: DR. JOYCE WENDELL 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	069305	NY

General Provider Information

NPI Number	:	1790789402
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOYCE WENDELL LCSW

Provider Business Mailing Address
First Line	:	184 FOREST GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1721
Country	:	US
Telephone Number	:	718-948-2227
Fax Number	:	718-948-5580

Provider Business Practice Location Address
First Line	:	184 FOREST GRN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-1721
Country	:	US
Telephone Number	:	718-948-2227
Fax Number	:	718-948-5580

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	07/09/2007

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