Provider Demographics
NPI:1609582279
Name:WELLSPRINGS CLINICAL SOCIAL WORK PLLC
Entity Type:Organization
Organization Name:WELLSPRINGS CLINICAL SOCIAL WORK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWR
Authorized Official - Phone:347-651-0900
Mailing Address - Street 1:446 E MEADOW AVE UNIT 723
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-6024
Mailing Address - Country:US
Mailing Address - Phone:347-651-0900
Mailing Address - Fax:888-901-8693
Practice Address - Street 1:109 N 12TH ST FL 8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1008
Practice Address - Country:US
Practice Address - Phone:347-651-0900
Practice Address - Fax:888-901-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY077662Medicaid