Provider Demographics
NPI:1780271692
Name:CHILDREN'S WELLNESS SERVICES, PLLC
Entity type:Organization
Organization Name:CHILDREN'S WELLNESS SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING ORGANIZATION
Authorized Official - Prefix:
Authorized Official - First Name:SHELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:DRY
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:212-401-4835
Mailing Address - Street 1:3545 28TH ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3201
Mailing Address - Country:US
Mailing Address - Phone:212-401-4835
Mailing Address - Fax:
Practice Address - Street 1:807 CHURCH ST APT 501
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3767
Practice Address - Country:US
Practice Address - Phone:212-401-4835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-26
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty