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General NPI Number Information
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NPI Number | 1508020041
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Entity Type | Individual
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Provider Name | WENDY GAIL LICHTENTHAL PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | 300 E 66TH ST
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City | NEW YORK
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State | NY
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Zip | 10065-6800
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Country | US
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Telephone | 646-608-8204
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Fax |
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Provider Business Mailing Address
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Address Line | 321 EAST 61ST STREET
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City | NEW YORK
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State | NY
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Zip | 10065
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Country | US
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Telephone | 215-620-3220
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Fax |
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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 | 35SI00561100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 017968-1
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License Number State | NY
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