Healthcare Provider Details

I. General information

NPI: 1215691019
Provider Name (Legal Business Name): ABIGAIL WREN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WESTCHESTER AVE STE LN02
WHITE PLAINS NY
10604-2912
US

IV. Provider business mailing address

8 W 75TH ST APT 3BC
NEW YORK NY
10023-2045
US

V. Phone/Fax

Practice location:
  • Phone: 720-940-5252
  • Fax:
Mailing address:
  • Phone: 720-940-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number024371
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: