MEDICARE: DR. LISA MARIA WU PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	016560	NY
2	103TB0200X	Cognitive & Behavioral Psychologist	016560	NY
3	103TC0700X	Clinical Psychologist	016560	NY
4	103TH0004X	Health Psychologist	016560	NY
5	103TP2701X	Group Psychotherapy Psychologist	016560	NY
6	103TR0400X	Rehabilitation Psychologist	016560	NY

General Provider Information

NPI Number	:	1144592312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA MARIA WU PH.D.

Provider Business Mailing Address
First Line	:	56 COURT ST APT 6A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-4904
Country	:	US
Telephone Number	:	347-235-9369
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 E 43RD ST RM 2202
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4718
Country	:	US
Telephone Number	:	347-235-9369
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	02/03/2012

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