MEDICARE: ANNA CAITLENN WADE PHD

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	103T00000X	Psychologist	P131422	NY

General Provider Information

NPI Number	:	1942023742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA CAITLENN WADE PHD

Provider Business Mailing Address
First Line	:	3705 30TH ST APT 501
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-2685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 E 124TH ST FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10035-1924
Country	:	US
Telephone Number	:	718-484-1303
Fax Number	:

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

Provider Enumeration Date	:	11/01/2024
Last Update Date	:	11/01/2024

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Directions to “ ANNA CAITLENN WADE PHD” Practice Location

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