Provider Demographics
NPI:1083158471
Name:WENCEK, PAUL (LMSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WENCEK
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2654 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4209
Mailing Address - Country:US
Mailing Address - Phone:585-723-7350
Mailing Address - Fax:585-723-7353
Practice Address - Street 1:2654 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4209
Practice Address - Country:US
Practice Address - Phone:585-723-7350
Practice Address - Fax:585-723-7353
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090423-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1255482535Medicaid