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General NPI Number Information
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NPI Number | 1447651989
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Entity Type | Individual
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Provider Name | RENATA VAYSMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/15/2014
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 2925 W 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11224
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Country | US
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Telephone | 718-616-6034
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Fax | 718-616-5694
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Provider Business Mailing Address
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Address Line | 2925 W 19TH ST
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City | BROOKLYN
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State | NY
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Zip | 11224-2501
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Country | US
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Telephone | 718-616-6034
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Fax | 718-616-5694
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22124
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License Number State | NY
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