Wellsley Brielle Radecke, LMFT

Primary specialty

PsychologistTaxonomy code 103T00000X

License

025317-01 Issued in NY

Practice address

1031 E Fayette St
Syracuse, NY 13210-1022

Phone

(315) 732-3431

NPI assigned

May 19, 2021

Sex

Female

Sole proprietor

No

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": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1952975336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 HARBRIDGE MNR",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142215830",
            "telephone_number": "716-574-3311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1031 E FAYETTE ST",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132101022",
            "telephone_number": "315-732-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RADECKE",
        "first_name": "WELLSLEY",
        "middle_name": "BRIELLE",
        "credential": "LMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-19",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NY",
            "license": "001404",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "025317-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Grace Rachetta
• Stephan J Rachfal, MD
• Michael Alexander Rachun, MD
• Gabrielle Racines, NP
• Jeremy Raciti, PA
• Kelly Marie Radford, LPN
• Radiotherapy Assoc. of Upstate Ny
• Nevena Radonjic, M.D., PHD
• Mary Elizabeth-Wilk Radtke, RN
• Eusha Abdul Raffay, MD

• Psychologist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.