Healthcare Provider Details

I. General information

NPI: 1295979458
Provider Name (Legal Business Name): CARRIE ANN ZLOTNICK-WOLDENBERG PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 90TH ST SUITE 1F
NEW YORK NY
10024-1234
US

IV. Provider business mailing address

200 W 90TH ST SUITE 1F
NEW YORK NY
10024-1234
US

V. Phone/Fax

Practice location:
  • Phone: 917-757-6749
  • Fax:
Mailing address:
  • Phone: 917-757-6749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number014624
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: