Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 017817 | NY |
N | 103TA0700X | Adult Development & Aging Psychologist | 017817 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 017817 | NY |
N | 103G00000X | Clinical Psychologist | 017817 | NY |
N | 103TC0700X | Clinical Psychologist | 017817 | NY |
N | 103TF0000X | Family Psychologist | 017817 | NY |
Y | 103TF0200X | Forensic Psychologist | 017817 | NY |
N | 103TP2701X | Group Psychotherapist | 017817 | NY |
NPI | 1154959963 |
---|---|
Provider Name | Dr. Timothy James Wisniewski |
First Address | Albany, NY 12206-1514 |
Second Address | Albany, NY 12206-1514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2020 |
Last Update Date | 28/03/2020 |