Provider Demographics
NPI:1114641206
Name:WISNIEWSKA, EVELINA (MHC-LP)
Entity Type:Individual
Prefix:
First Name:EVELINA
Middle Name:
Last Name:WISNIEWSKA
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 ST PAULS AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3239
Mailing Address - Country:US
Mailing Address - Phone:718-619-3533
Mailing Address - Fax:
Practice Address - Street 1:690 CASTLETON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-1822
Practice Address - Country:US
Practice Address - Phone:718-876-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health