Healthcare Provider Details

I. General information

NPI: 1205441243
Provider Name (Legal Business Name): ACORN TO OAK WELLNESS STUDIO, LCSW, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 S HIGHLAND AVE
PEARL RIVER NY
10965-1614
US

IV. Provider business mailing address

70 S HIGHLAND AVE
PEARL RIVER NY
10965-1614
US

V. Phone/Fax

Practice location:
  • Phone: 860-318-1158
  • Fax:
Mailing address:
  • Phone: 860-318-1158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER RANKIN
Title or Position: OWNER, CLINICIAN
Credential: M.ED; LCSW
Phone: 860-318-1158