Provider Demographics
NPI:1699830083
Name:WHEELOCK, DAVID (LCSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:WHEELOCK
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3011
Mailing Address - Country:US
Mailing Address - Phone:516-376-0576
Mailing Address - Fax:
Practice Address - Street 1:569 W PARK AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3011
Practice Address - Country:US
Practice Address - Phone:516-376-0576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047075-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY162465OtherVALUE OPTIONS PROVIDER NO
NYN67101Medicare ID - Type Unspecified