Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 016089 | NY |
N | 103T00000X | Psychologist | 016089 | NY |
N | 103G00000X | Clinical Psychologist | 016089 | NY |
N | 103TC0700X | Clinical Psychologist | 016089 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 016089 | NY |
N | 103TF0000X | Family Psychologist | 016089 | NY |
NPI | 1033265806 |
---|---|
Provider Name | Dr. Stephen Jeffrey Wakschal |
First Address | Staten Island, NY 10314-6625 |
Second Address | Staten Island, NY 10314-6625 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q32943 | (02) |