Healthcare Provider Details

I. General information

NPI: 1861702821
Provider Name (Legal Business Name): MS. JUDY LYNN WURSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HUSKIE LN
MALONE NY
12953-2450
US

IV. Provider business mailing address

65 LAPOINT RD
ELLENBURG DEPOT NY
12935-3443
US

V. Phone/Fax

Practice location:
  • Phone: 518-483-5230
  • Fax:
Mailing address:
  • Phone: 518-492-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: