Provider Demographics
NPI:1154653889
Name:WOLCHETSKY, KAREN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:WOLCHETSKY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 E. GREEN ST. 5TH FL.
Mailing Address - Street 2:ALCOHOL AND DRUG COUNCIL OF TOMPKINS COUNTY
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5635
Mailing Address - Country:US
Mailing Address - Phone:607-274-6288
Mailing Address - Fax:607-274-6280
Practice Address - Street 1:201 E GREEN ST
Practice Address - Street 2:5TH FL.
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5635
Practice Address - Country:US
Practice Address - Phone:607-274-6288
Practice Address - Fax:607-274-6280
Is Sole Proprietor?:No
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY484936-1101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)