Provider Demographics
NPI:1285612127
Name:WENZ, LAWRENCE JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:WENZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:LAWRENCE
Other - Middle Name:J
Other - Last Name:WENZ, PSY.D., P.C.
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:151 CONKLIN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-3644
Mailing Address - Country:US
Mailing Address - Phone:845-782-0872
Mailing Address - Fax:845-782-2586
Practice Address - Street 1:151 CONKLIN RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-3644
Practice Address - Country:US
Practice Address - Phone:845-782-0872
Practice Address - Fax:845-782-2586
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-31
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8688103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01969951Medicaid