Healthcare Provider Details

I. General information

NPI: 1144592312
Provider Name (Legal Business Name): LISA MARIA WU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2012
Last Update Date: 02/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 E 43RD ST RM 2202
NEW YORK NY
10017-4718
US

IV. Provider business mailing address

56 COURT ST APT 6A
BROOKLYN NY
11201-4904
US

V. Phone/Fax

Practice location:
  • Phone: 347-235-9369
  • Fax:
Mailing address:
  • Phone: 347-235-9369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number016560
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number016560
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016560
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number016560
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number016560
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number016560
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: