Provider Demographics
NPI:1538388418
Name:TIRRO, WENDY E (MSSA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:TIRRO
Suffix:
Gender:F
Credentials:MSSA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:C
Other - Last Name:EFFRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2526 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-4418
Mailing Address - Country:US
Mailing Address - Phone:941-302-8524
Mailing Address - Fax:
Practice Address - Street 1:2526 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-4418
Practice Address - Country:US
Practice Address - Phone:941-302-8524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0789111041C0700X
NYR078911-011041C0700X
FLSW8100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1538388418OtherPRIVATE INSURANCE