Provider Demographics
NPI:1376975979
Name:NURTURING LIFE CONCEPTS
Entity Type:Organization
Organization Name:NURTURING LIFE CONCEPTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:WEST PIDKAMINY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:315-682-4005
Mailing Address - Street 1:8195 CAZENOVIA RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9631
Mailing Address - Country:US
Mailing Address - Phone:315-682-4005
Mailing Address - Fax:315-682-4254
Practice Address - Street 1:8195 CAZENOVIA RD
Practice Address - Street 2:SUITE 9
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9631
Practice Address - Country:US
Practice Address - Phone:315-682-4005
Practice Address - Fax:315-682-4254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076350-1251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health