Provider Demographics
NPI:1215259379
Name:WEST PIDKAMINY, WENDY A (LCSW-R)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:A
Last Name:WEST PIDKAMINY
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8195 CAZENOVIA RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9631
Mailing Address - Country:US
Mailing Address - Phone:315-682-4005
Mailing Address - Fax:
Practice Address - Street 1:8195 CAZENOVIA RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9631
Practice Address - Country:US
Practice Address - Phone:315-682-4005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076350-11041C0700X
NY21560481041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool