Individual
THOMAS WIELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MFT
Contact information
Practice address
107 W MAIN ST, EAST ISLIP, NY 11730-2337
(631) 666-1615
Mailing address
107 W MAIN ST, EAST ISLIP, NY 11730-2337
(631) 666-1615
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
001302-1
NY
Other
Enumeration date
03/27/2016
Last updated
03/27/2016
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