Provider Demographics
NPI:1922585363
Name:PSYCHOLOGY WELLNESS PRACTICE, PLLC.
Entity Type:Organization
Organization Name:PSYCHOLOGY WELLNESS PRACTICE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITKIN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:518-573-7024
Mailing Address - Street 1:950 NEW LOUDON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2100
Mailing Address - Country:US
Mailing Address - Phone:518-573-7024
Mailing Address - Fax:
Practice Address - Street 1:950 NEW LOUDON RD STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2100
Practice Address - Country:US
Practice Address - Phone:518-573-7024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty