Provider Demographics
NPI:1881997476
Name:WELLS, AMIE DANIELLA (MHC-LP)
Entity type:Individual
Prefix:
First Name:AMIE
Middle Name:DANIELLA
Last Name:WELLS
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 CRISPUS ATTUCKS PL
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1909
Mailing Address - Country:US
Mailing Address - Phone:617-606-2387
Mailing Address - Fax:
Practice Address - Street 1:315 WYCKOFF AVE STE 6
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5842
Practice Address - Country:US
Practice Address - Phone:718-497-6090
Practice Address - Fax:718-497-6262
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP07740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health