Provider Demographics
NPI:1184773145
Name:WELLS, ELOIS (LCSW-R)
Entity type:Individual
Prefix:MRS
First Name:ELOIS
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 ASHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-1815
Mailing Address - Country:US
Mailing Address - Phone:315-735-1612
Mailing Address - Fax:
Practice Address - Street 1:4277 MIDDLE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-5315
Practice Address - Country:US
Practice Address - Phone:315-735-6484
Practice Address - Fax:315-735-8545
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052669-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical