Provider Demographics
NPI:1871656454
Name:PENZEL, WENDY R (PSYD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:R
Last Name:PENZEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 NEW YORK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4240
Mailing Address - Country:US
Mailing Address - Phone:631-673-1225
Mailing Address - Fax:631-424-4041
Practice Address - Street 1:755 NEW YORK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4240
Practice Address - Country:US
Practice Address - Phone:631-673-1225
Practice Address - Fax:631-424-4041
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015381103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV297H1Medicare ID - Type Unspecified