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General NPI Number Information
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NPI Number | 1376064436
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Entity Type | Organization
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Legal Business Name | DREAM WISE, LLC
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 05/03/2021
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Provider Practice Location Address
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Address Line | 290 PRATT STREET
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City | MERIDEN
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State | CT
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Zip | 06450-8600
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Country | US
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Telephone | 203-910-8079
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Fax | 203-405-5803
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Provider Business Mailing Address
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Address Line | PO BOX 1907
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City | MERIDEN
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State | CT
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Zip | 06450-7059
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Country | US
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Telephone | 203-910-8079
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Fax | 203-405-8600
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Authorized Official
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Title or Position | OWNER
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Name | MS. NATACHA KERELEJZA
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Credential | LCSW
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Telephone | 203-910-8079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 006421
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License Number State | CT
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