Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 023818 | NY |
Y | 103TC0700X | Clinical Psychologist | 023818 | NY |
NPI | 1003420506 |
---|---|
Provider Name | Talia Wigod |
First Address | White Plains, NY 10601-2320 |
Second Address | White Plains, NY 10601-2320 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2020 |
Last Update Date | 02/09/2020 |