Provider Demographics
NPI:1386467058
Name:CONNECTED TREASURES. LCSW, PLLC
Entity type:Organization
Organization Name:CONNECTED TREASURES. LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:315-758-0587
Mailing Address - Street 1:106 HIGH ST STE B
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1471
Mailing Address - Country:US
Mailing Address - Phone:315-758-0587
Mailing Address - Fax:315-704-5712
Practice Address - Street 1:106 HIGH ST STE B
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1471
Practice Address - Country:US
Practice Address - Phone:315-758-0587
Practice Address - Fax:315-704-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY07961668Medicaid