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General NPI Number Information
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NPI Number | 1760231328
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Entity Type | Individual
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Provider Name | DAVID ALEC WIERZBICKI PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2024
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 205 HUDSON ST FL 9
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City | NEW YORK
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State | NY
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Zip | 10013-1810
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 125 E STATE ST APT 10H
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City | ITHACA
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State | NY
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Zip | 14850-5386
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Country | US
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Telephone | 610-451-3783
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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 | 025789-01
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License Number State | NY
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