Healthcare Provider Details

I. General information

NPI: 1841353182
Provider Name (Legal Business Name): NORMAN HOWARD WYLOGE PH.D, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 E 76TH ST FL 3
NEW YORK NY
10021-2755
US

IV. Provider business mailing address

52 E 76TH ST FL 3
NEW YORK NY
10021-2755
US

V. Phone/Fax

Practice location:
  • Phone: 914-659-3191
  • Fax:
Mailing address:
  • Phone: 914-659-3191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP00815
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: