Provider Demographics
NPI:1639334857
Name:WELLS, SOLOMON (LMHC, CASAC)
Entity Type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:
Last Name:WELLS
Suffix:
Gender:M
Credentials:LMHC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SICKLES ST APT 4I
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1833
Mailing Address - Country:US
Mailing Address - Phone:917-684-8100
Mailing Address - Fax:212-239-0948
Practice Address - Street 1:19 W 34TH ST STE PH
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3006
Practice Address - Country:US
Practice Address - Phone:212-347-7111
Practice Address - Fax:212-239-0948
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY19640101YA0400X
NY005017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)