Healthcare Provider Details

I. General information

NPI: 1124265244
Provider Name (Legal Business Name): JESSICA WULF PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2009
Last Update Date: 01/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 NATHAN D PERLMAN PL 6 BERNSTEIN 6B40C
NEW YORK NY
10003-3801
US

IV. Provider business mailing address

9 NATHAN D PERLMAN PL 6 BERNSTEIN 6B40C
NEW YORK NY
10003-3801
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-3846
  • Fax: 212-674-3828
Mailing address:
  • Phone: 212-420-3846
  • Fax: 212-674-3828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0173261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: