Provider Demographics
NPI:1063952307
Name:VILLAFANA, WENDY CATALINA (LMSW, CASAC)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:CATALINA
Last Name:VILLAFANA
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BEACH 28TH ST FL 3
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2200
Mailing Address - Country:US
Mailing Address - Phone:917-842-4220
Mailing Address - Fax:
Practice Address - Street 1:9609 40TH RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2138
Practice Address - Country:US
Practice Address - Phone:929-522-0631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22560101YA0400X
NY0996791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)