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General NPI Number Information
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NPI Number | 1841353182
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Entity Type | Individual
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Provider Name | NORMAN HOWARD WYLOGE PH.D, LCSW
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 52 E 76TH ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10021-2755
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Country | US
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Telephone | 914-659-3191
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Fax |
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Provider Business Mailing Address
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Address Line | 52 E 76TH ST FL 3
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City | NEW YORK
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State | NY
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Zip | 10021-2755
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Country | US
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Telephone | 914-659-3191
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P00815
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License Number State | NY
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