Wanda Chisolm, LMHC, CASAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

007206 Issued in NY

Practice address

107 East Main Street
East Islip, NY 11730

Phone

(631) 666-1615

NPI assigned

Apr 15, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460678400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555372800000",
    "number": "1629422639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1062",
            "city": "BAY SHORE",
            "state": "NY",
            "postal_code": "117060534",
            "telephone_number": "917-618-0081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 EAST MAIN STREET",
            "city": "EAST ISLIP",
            "state": "NY",
            "postal_code": "11730",
            "telephone_number": "631-666-1615"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "268 Delaware Ave",
            "address_purpose": "LOCATION",
            "city": "Bay Shore",
            "state": "NY",
            "postal_code": "117063345",
            "country_code": "US",
            "telephone_number": "631-328-1303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHISOLM",
        "first_name": "WANDA",
        "credential": "LMHC, CASAC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-15",
        "last_updated": "2019-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NY",
            "license": "23644",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NY",
            "license": "007206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kerrie-Anne Cera
• Kevin Chen
• Megan Chheda, PHARMD
• Bonnie Susan Chindamo, NP
• John Francis Chinnici, DC
• Esther Choi
• Solaiman Chowdhury
• Christine M Galante Nurse Practitioner in Psychiatry, PLLC
• Jaclyn Cinquemani, M.A., BCBA
• John Francis Cody, OTR/L

• Mental Health Counselor in East Islip, NY
• Providers in East Islip, NY by specialty
• Mental Health Counselor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.