Provider Demographics
NPI:1649573775
Name:WHEELER, JENNIFER BATES (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BATES
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 1:165 CHRISTOPHER ST
Mailing Address - Street 2:SUITE 6S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-2803
Mailing Address - Country:US
Mailing Address - Phone:917-371-8788
Mailing Address - Fax:
Practice Address - Street 1:307 7TH AVE
Practice Address - Street 2:SUITE 1402
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6007
Practice Address - Country:US
Practice Address - Phone:917-371-8788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-12
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076858-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300067514OtherMEDICARE PTAN