Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 016173 | NY |
Y | 103TH0004X | Health Psychologist | 016173 | NY |
NPI | 1265679039 |
---|---|
Provider Name | Willo Wisotsky |
First Address | Commack, NY 11725-5415 |
Second Address | Commack, NY 11725-5415 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2009 |
Last Update Date | 06/09/2018 |