Provider Demographics
NPI:1720327943
Name:PATULSKI, WALLIS ELIZABETH (LCSW-R, MED)
Entity Type:Individual
Prefix:MS
First Name:WALLIS
Middle Name:ELIZABETH
Last Name:PATULSKI
Suffix:
Gender:F
Credentials:LCSW-R, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10507 HINMAN RD
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304-1806
Mailing Address - Country:US
Mailing Address - Phone:315-219-3834
Mailing Address - Fax:
Practice Address - Street 1:10507 HINMAN RD
Practice Address - Street 2:
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304-1806
Practice Address - Country:US
Practice Address - Phone:315-219-3834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500795571041C0700X
NYR0797501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical