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General NPI Number Information
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NPI Number | 1851537773
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Entity Type | Organization
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Legal Business Name | EMILY R. WILDMAN, PSY.D., LLC
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Dates
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Enumeration Date | 12/23/2008
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Last Update Date | 01/24/2012
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Provider Practice Location Address
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Address Line | 2824 ALHAMBRA DR
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City | BELMONT
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State | CA
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Zip | 94002-1352
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Country | US
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Telephone | 650-453-3125
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Fax |
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Provider Business Mailing Address
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Address Line | 2824 ALHAMBRA DR
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City | BELMONT
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State | CA
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Zip | 94002-1352
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Country | US
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Telephone | 650-453-3125
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | EMILY R. WILDMAN
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Credential | PSY.D.
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Telephone | 973-615-5755
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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 | 35S100396400
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License Number State | NJ
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