Basic Information
| Provider Information | |||||||||
| NPI: | 1689044562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WIERZBICKI | ||||||||
| FirstName: | CONNIE | ||||||||
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| Credential: | CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 704 COUNTY ROUTE 37 | ||||||||
| Address2: | |||||||||
| City: | CENTRAL SQUARE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130362138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156015829 | ||||||||
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| Practice Location | |||||||||
| Address1: | 526 OLD LIVERPOOL RD | ||||||||
| Address2: | |||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130886238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154533911 | ||||||||
| FaxNumber: | 3154530197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2015 | ||||||||
| LastUpdateDate: | 04/13/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 21900 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.