Provider Demographics
NPI:1811655517
Name:WOZNIKAITIS, WAYNE JUSTIN
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:JUSTIN
Last Name:WOZNIKAITIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 WYOMING AVE STE 2E
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1600
Mailing Address - Country:US
Mailing Address - Phone:570-690-5356
Mailing Address - Fax:
Practice Address - Street 1:295 WYOMING AVE STE 2E
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1600
Practice Address - Country:US
Practice Address - Phone:570-690-5356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-30
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014027101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional