MEDICARE: MRS. NEILA COHALAN WYMAN LCSW, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	000687	NY
2	1041C0700X	Clinical Social Worker	R035636	NY

General Provider Information

NPI Number	:	1649416785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NEILA COHALAN WYMAN LCSW, PA

Provider Business Mailing Address
First Line	:	118 W 80TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6351
Country	:	US
Telephone Number	:	212-362-0148
Fax Number	:	212-874-6814

Provider Business Practice Location Address
First Line	:	118 W 80TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6351
Country	:	US
Telephone Number	:	212-362-0148
Fax Number	:	212-874-6814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2008
Last Update Date	:	12/19/2008

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