Healthcare Provider Details

I. General information

NPI: 1790904837
Provider Name (Legal Business Name): JOAN WOLKIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 PARK AVE APT. 10D
NEW YORK NY
10128-1758
US

IV. Provider business mailing address

1225 PARK AVE APT. 10D
NEW YORK NY
10128-1758
US

V. Phone/Fax

Practice location:
  • Phone: 212-831-4667
  • Fax: 212-831-4667
Mailing address:
  • Phone: 212-831-4667
  • Fax: 212-831-4667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number008765-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberSI0-2296
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number008765-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: