Provider Demographics
NPI:1215747522
Name:NEW WINGS MENTAL HEALTH COUNSELING, P.C.
Entity type:Organization
Organization Name:NEW WINGS MENTAL HEALTH COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:AYER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:315-630-8314
Mailing Address - Street 1:112 CAROLINE ST
Mailing Address - Street 2:
Mailing Address - City:CANASTOTA
Mailing Address - State:NY
Mailing Address - Zip Code:13032-1205
Mailing Address - Country:US
Mailing Address - Phone:315-630-8314
Mailing Address - Fax:316-907-6156
Practice Address - Street 1:11 MADISON BLVD STE 17
Practice Address - Street 2:
Practice Address - City:CANASTOTA
Practice Address - State:NY
Practice Address - Zip Code:13032-3508
Practice Address - Country:US
Practice Address - Phone:315-630-8314
Practice Address - Fax:315-907-6156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1386227684Medicaid