Provider Demographics
NPI:1972938256
Name:PORRATA, WENDY VIMARY (LMSW)
Entity type:Individual
Prefix:MS
First Name:WENDY
Middle Name:VIMARY
Last Name:PORRATA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 RANDALL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2410
Mailing Address - Country:US
Mailing Address - Phone:917-770-3224
Mailing Address - Fax:
Practice Address - Street 1:4123 THIRD AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457
Practice Address - Country:US
Practice Address - Phone:718-299-3045
Practice Address - Fax:718-716-2604
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01Medicaid
02Medicare PIN
02Medicare UPIN