Provider Demographics
NPI:1376064436
Name:DREAM WISE, LLC
Entity Type:Organization
Organization Name:DREAM WISE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATACHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERELEJZA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-910-8079
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7059
Mailing Address - Country:US
Mailing Address - Phone:203-910-8079
Mailing Address - Fax:203-405-8600
Practice Address - Street 1:290 PRATT STREET
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-8600
Practice Address - Country:US
Practice Address - Phone:203-910-8079
Practice Address - Fax:203-405-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0064211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008072080Medicaid