Provider Demographics
NPI:1477251239
Name:WESOLOSKI, EMILY ELIANE (LMSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELIANE
Last Name:WESOLOSKI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 BENHAM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-1203
Mailing Address - Country:US
Mailing Address - Phone:607-743-5869
Mailing Address - Fax:
Practice Address - Street 1:125 BENHAM ST APT 1
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1203
Practice Address - Country:US
Practice Address - Phone:607-743-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115193-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker