Individual provider Active NPI

Wendy Elizabeth Nelson, MENTAL HEALTH THERAP

  • Marriage & Family Therapist
  • New York, NY
National Provider Identifier
1083822258
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
000401 Issued in NY
Practice address
124 W 79TH St
Suite 1B
New York, NY 10024-6470
Phone
(212) 721-0336
NPI assigned
May 19, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 002420 NY
Marriage & Family Therapist 106H00000X 000401 NY Primary

Addresses

Primary practice location

124 W 79TH St
Suite 1B
New York, NY 10024-6470

Mailing address

124 W 79TH St
Suite 1B
New York, NY 10024-6470
Phone (212) 721-0336

Other identifiers 2

IdentifierTypeStateIssuer
002420OtherNYMENTAL HEALTH THERAPIST
000401OtherNYMARRIAGE AND FAMILY THERA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
000401NYMDPsychoanalyst
002420NYMDAcupuncturist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315526400000",
    "number": "1083822258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 W 79TH ST",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246470",
            "telephone_number": "212-721-0336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W 79TH ST",
            "address_2": "SUITE 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100246470",
            "telephone_number": "212-721-0336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NELSON",
        "first_name": "WENDY",
        "middle_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "MENTAL HEALTH THERAP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-19",
        "last_updated": "2011-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "002420",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "000401",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MENTAL HEALTH THERAPIST",
            "identifier": "002420",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIAGE AND FAMILY THERA",
            "identifier": "000401",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.