=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386467058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONNECTED TREASURES. LCSW, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 HIGH ST STE B
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14513-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-758-0587
-----------------------------------------------------
Fax | 315-704-5712
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 HIGH ST STE B
-----------------------------------------------------
City | NEWARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14513-1471
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-758-0587
-----------------------------------------------------
Fax | 315-704-5712
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KATHERINE WHEELER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 315-758-0587
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------