Provider Demographics
NPI:1447916390
Name:WISE THERAPY LCSW PC
Entity type:Organization
Organization Name:WISE THERAPY LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R,PHD,CST/CSTS
Authorized Official - Phone:917-727-0522
Mailing Address - Street 1:60 PLAZA ST E APT 1G
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5030
Mailing Address - Country:US
Mailing Address - Phone:917-727-0522
Mailing Address - Fax:
Practice Address - Street 1:60 PLAZA ST E # BS-1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5025
Practice Address - Country:US
Practice Address - Phone:917-822-5045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty