Healthcare Provider Details

I. General information

NPI: 1154254761
Provider Name (Legal Business Name): WOLF HAVEN NP IN PSYCHIATRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MADISON AVE
HEMPSTEAD NY
11550-4811
US

IV. Provider business mailing address

15 MADISON AVE
HEMPSTEAD NY
11550-4811
US

V. Phone/Fax

Practice location:
  • Phone: 516-566-3629
  • Fax:
Mailing address:
  • Phone: 516-566-3629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WOLF VERRDINER
Title or Position: PMHNP
Credential:
Phone: 516-566-3629