Provider Demographics
NPI:1487745709
Name:CARMAN, WENDY J (LCSW)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:J
Last Name:CARMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 S CROUSE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1845
Mailing Address - Country:US
Mailing Address - Phone:315-233-1212
Mailing Address - Fax:315-708-0041
Practice Address - Street 1:315 S CROUSE AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1845
Practice Address - Country:US
Practice Address - Phone:315-233-1212
Practice Address - Fax:315-708-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2010-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR 040658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56331BMedicare PIN