Healthcare Provider Details

I. General information

NPI: 1841214418
Provider Name (Legal Business Name): REBECCA L WULF LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3312 SURF AVE
BROOKLYN NY
11224-1406
US

IV. Provider business mailing address

7618 69TH PL APT 3D
GLENDALE NY
11385-7136
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-3300
  • Fax:
Mailing address:
  • Phone: 347-813-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073893-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: