Healthcare Provider Details

I. General information

NPI: 1366367674
Provider Name (Legal Business Name): EMILY WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 GRAHAM AVE
BROOKLYN NY
11211-3735
US

IV. Provider business mailing address

30 WEST ST APT 24C
NEW YORK NY
10004-3059
US

V. Phone/Fax

Practice location:
  • Phone: 718-785-9718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number002827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: