Provider Demographics
NPI:1649370578
Name:MCLAUCHLIN, WENONAH (MA-ATR-BC, LCAT)
Entity type:Individual
Prefix:
First Name:WENONAH
Middle Name:
Last Name:MCLAUCHLIN
Suffix:
Gender:F
Credentials:MA-ATR-BC, LCAT
Other - Prefix:
Other - First Name:WENONAH
Other - Middle Name:
Other - Last Name:TANTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA-ATR-BC, LCAT
Mailing Address - Street 1:257 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-6103
Mailing Address - Country:US
Mailing Address - Phone:518-456-7950
Mailing Address - Fax:
Practice Address - Street 1:257 CHURCH RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-6103
Practice Address - Country:US
Practice Address - Phone:518-456-7950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000912-1221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist