Healthcare Provider Details

I. General information

NPI: 1417146226
Provider Name (Legal Business Name): HEALTHWISE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 10/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAY RIDGE AVE
BROOKLYN NY
11220-5053
US

IV. Provider business mailing address

110 BAY RIDGE AVE
BROOKLYN NY
11220-5053
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-1395
  • Fax: 718-745-2092
Mailing address:
  • Phone: 718-745-1395
  • Fax: 718-745-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. FREDRIC DAVIN SHULMAN
Title or Position: EXECUTIVE DIRECTOR
Credential: PH.D.
Phone: 718-745-1395