Provider Demographics
NPI:1528482239
Name:HEALTHWISE COUNSELING LCSW, PLLC
Entity type:Organization
Organization Name:HEALTHWISE COUNSELING LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MAZZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CASAC, ACSW
Authorized Official - Phone:631-403-0813
Mailing Address - Street 1:4230 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5700
Mailing Address - Country:US
Mailing Address - Phone:631-403-0813
Mailing Address - Fax:516-509-4263
Practice Address - Street 1:4230 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE 200
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5700
Practice Address - Country:US
Practice Address - Phone:631-403-0813
Practice Address - Fax:516-509-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0802441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100116490Medicare UPIN