Provider Demographics
NPI:1437636560
Name:WHEELER, KATE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KATE
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 MESEROLE ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-2050
Mailing Address - Country:US
Mailing Address - Phone:919-812-4210
Mailing Address - Fax:
Practice Address - Street 1:112 MESEROLE ST APT 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2050
Practice Address - Country:US
Practice Address - Phone:919-812-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-21
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490206341041C0700X
NY0906441041C0700X
NY097820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY090644OtherNEW YORK STATE DEPARTMENT OF EDUCATION
IL149020634OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION
NY090644OtherNEW YORK STATE DEPARTMENT OF EDUCATION