Healthcare Provider Details

I. General information

NPI: 1538541818
Provider Name (Legal Business Name): ALESYA WULFING LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 MADISON AVE
NEW YORK NY
10016-2401
US

IV. Provider business mailing address

1B CARROLL ST
BRONX NY
10464-1428
US

V. Phone/Fax

Practice location:
  • Phone: 914-257-3727
  • Fax:
Mailing address:
  • Phone: 347-444-3355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number18 006621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: