Healthcare Provider Details

I. General information

NPI: 1215019286
Provider Name (Legal Business Name): LYNN A. WASIELEWSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 SPRUCE STREET NORTH COLLINS
NORTH COLLINS NY
14111
US

IV. Provider business mailing address

PO BOX 458 2107 SPRUCE STREET, NORTH COLLINS
NORTH COLLINS NY
14111
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax: 716-337-2723
Mailing address:
  • Phone: 716-337-3706
  • Fax: 716-337-2723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number052867-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: