Provider Demographics
NPI:1427107523
Name:WECHSLER, MARTIN (LCSWR)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:
Last Name:WECHSLER
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 STONEGATE RD
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588-1805
Mailing Address - Country:US
Mailing Address - Phone:914-582-2585
Mailing Address - Fax:914-582-2585
Practice Address - Street 1:199 MAIN ST STE 200
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3204
Practice Address - Country:US
Practice Address - Phone:914-288-9281
Practice Address - Fax:914-288-9281
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR025579101YM0800X
NYR025579-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY108723OtherHEALTHNET
NY140025579NY01OtherANTHEM
NYN33131Medicare PIN