Provider Demographics
NPI:1760237903
Name:WOUNDED HEALERS
Entity Type:Organization
Organization Name:WOUNDED HEALERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR/LMHC
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PACITTI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:716-499-6418
Mailing Address - Street 1:2115 PECK SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-9262
Mailing Address - Country:US
Mailing Address - Phone:716-499-6418
Mailing Address - Fax:716-306-4819
Practice Address - Street 1:2115 PECK SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-9262
Practice Address - Country:US
Practice Address - Phone:716-499-6418
Practice Address - Fax:716-306-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1841926185OtherLMHC