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NPI Code Detail

MEDICARE: WELLNESS COUNSELING SERVICES, LCSW, PLLC

MEDICARE: WELLNESS COUNSELING SERVICES, LCSW, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1831821289
Entity Type Code : Organization
Provider Name (Legal Business Name) : WELLNESS COUNSELING SERVICES, LCSW, PLLC
Provider Business Mailing Address
First Line : 2294 E 15TH ST APT 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-4640
Country : US
Telephone Number : 347-620-3339
Fax Number :
Provider Business Practice Location Address
First Line : 2294 E 15TH ST APT 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11229-4640
Country : US
Telephone Number : 347-620-3339
Fax Number :
Authorized Official
Title or Position : CLINICAL DIRECTOR
Name : MR. JASON ANTHONY DUCOS
Credential : LCSW-R, CASAC-MASTER
Telephone Number : 347-620-3339
Provider Enumeration Date : 06/25/2022
Last Update Date : 07/19/2022

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