Provider Demographics
NPI:1124609870
Name:GATEWAY TO WELLNESS, LCSW, PLLC
Entity type:Organization
Organization Name:GATEWAY TO WELLNESS, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & CLINICAL DIRECTOR, LCSW
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARNESECCHI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:800-333-4116
Mailing Address - Street 1:111 BROADWAY RM 905
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-2001
Mailing Address - Country:US
Mailing Address - Phone:646-529-8776
Mailing Address - Fax:
Practice Address - Street 1:111 BROADWAY RM 905
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2001
Practice Address - Country:US
Practice Address - Phone:646-529-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty