WANDA CHISOLM (NPI# 1629422639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629422639 |
| Entity Type | Individual |
| Full Name | WANDA CHISOLM |
| Credential | LMHC, CASAC |
| Practice Address |
107 East Main Street East Islip NY 11730 |
| Mailing Address |
Po Box 1062 Bay Shore NY 11706-0534 |
| Practice Telephone | 6316661615 |
| Mailing Telephone | 9176180081 |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2019-04-16 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
23644 | NY | Behavioral Health & Social Service Providers |
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
007206 | NY | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 268 Delaware Ave, Bay Shore, NY 117063345 | 6313281303 |
| Street Address |
107 EAST MAIN STREET |
| City | EAST ISLIP |
| State | NY |
| Zip Code | 11730 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568092583 | Exchange Ambulance Corporation of The Islips | Ambulance | 190 Carleton Avenue, East Islip, NY 11730 | 2020-01-17 |
| 1689040990 | Ryan George Baist | Pharmacist | 18 Argyle Drive, East Islip, NY 11730 | 2015-08-20 |
| 1225448855 | Michael John Desivo | Dentist | 228 East Main St, East Islip, NY 11730 | 2014-05-05 |
| 1306279401 | Eileen Henry | Specialist | 81 Country Village Lane, East Islip, NY 11730 | 2013-08-13 |
| 1124306659 | Carol A Ryan-behr | Licensed Practical Nurse | 145 Woodland Ave, East Islip, NY 11730 | 2011-08-02 |
| 1154651768 | Helene Dellas-dibona | Social Worker | 216 Carleton Avenue, East Islip, NY 11730 | 2010-01-04 |
| 1952513921 | Lorraine G Ballou | Social Worker | 31 Sherwood Drive, East Islip, NY 11730 | 2007-05-04 |
| 1235271362 | Robert Anthony Domozych Jr. | Dentist | 127 West Main Street, East Islip, NY 11730 | 2007-02-13 |
| 1477614766 | Kathleen O'neill | Counselor | 265 East Main Street, Tranquility Counseling, East Islip, NY 11730 | 2006-12-12 |
| 1811080617 | Robert J Maccone | Family Medicine | 45 East Main Street, East Islip, NY 11730 | 2006-10-02 |
| Find all providers in zip 11730 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124558499 | Gabrielle Marie Ricca-caldon | Counselor | 55 Carleton Ave Ste 5, East Islip, NY 11730-2133 | 2017-06-19 |
| 1053856781 | Suzanne Mason-grossmann | Counselor | 8 Greenwood Ave, East Islip, NY 11730-2138 | 2017-01-04 |
| 1073728580 | Michael Robert Hughes | Counselor | 134 E Madison St, East Islip, NY 11730-1614 | 2007-05-10 |
| 1487293387 | Gina Marie Kepler | Counselor | 107 W Main St, East Islip, NY 11730-2337 | 2019-12-26 |
| 1033772041 | Richard Paul Purslow | Counselor | 107 W Main St, East Islip, NY 11730-2337 | 2019-04-16 |
| 1477014439 | Jennie Berges | Counselor | 55 Carleton Ave Ste 5, East Islip, NY 11730-2133 | 2019-03-30 |
| 1750845285 | Lynda Phillips | Counselor | 107 W Main St, East Islip, NY 11730-2337 | 2019-01-29 |
| 1871066209 | Jonneigh Briody | Counselor | 55 Carleton Ave Ste 5, East Islip, NY 11730-2133 | 2019-01-08 |
| 1265902449 | Amanda Rose Cazalet | Counselor | 8 Greenwood Ave, East Islip, NY 11730-2138 | 2018-11-29 |
| 1649765207 | Kaitlin Dibella | Counselor | 55 Carleton Ave Ste 5, East Islip, NY 11730-2133 | 2018-06-26 |
| Find all providers in EAST ISLIP | ||||
| City | EAST ISLIP |
| Zip Code | 11730 |
Please comment or provide details below to improve the information on WANDA CHISOLM.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.