Provider Demographics
NPI:1962598607
Name:WENZEL, EVELYN M (LCSW, CAP)
Entity type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:M
Last Name:WENZEL
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 COUNTRY LAKES DR
Mailing Address - Street 2:
Mailing Address - City:BELLE ISLE
Mailing Address - State:FL
Mailing Address - Zip Code:32812-3530
Mailing Address - Country:US
Mailing Address - Phone:407-375-1214
Mailing Address - Fax:
Practice Address - Street 1:1850 LEE RD STE 215
Practice Address - Street 2:6700 S. FLORIDA AVE., SUITE 29 LAKELAND, FL
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2106
Practice Address - Country:US
Practice Address - Phone:407-375-1214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3086101YA0400X
FLSW57641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z002YOtherBLUE CROSS BLUE SHIELD-