Provider Demographics
NPI:1679858096
Name:WHEELER, JEAN M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:M
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 1:216 MAPLE HEIGHTS
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810
Mailing Address - Country:US
Mailing Address - Phone:607-776-4123
Mailing Address - Fax:607-776-4124
Practice Address - Street 1:216 MAPLE HEIGHTS
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810
Practice Address - Country:US
Practice Address - Phone:607-776-4123
Practice Address - Fax:607-776-4124
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078518-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical