MEDICARE: WENDY GOLUB

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	1041C0700X	Clinical Social Worker	RO22685-1	NY

General Provider Information

NPI Number	:	1710393855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WENDY GOLUB

Provider Business Mailing Address
First Line	:	302W 91ST ST 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-1011
Country	:	US
Telephone Number	:	212-787-7120
Fax Number	:	917-441-7421

Provider Business Practice Location Address
First Line	:	345 E 77TH ST
Second Line	:	#5G
City	:	NEW YORK
State	:	NY
Zip	:	10075-2270
Country	:	US
Telephone Number	:	221-287-9029
Fax Number	:

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

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/24/2025

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