Provider Demographics
NPI:1003420506
Name:WIGOD, TALIA (PSYD)
Entity Type:Individual
Prefix:
First Name:TALIA
Middle Name:
Last Name:WIGOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 N BROADWAY STE 704
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-2320
Mailing Address - Country:US
Mailing Address - Phone:516-359-8150
Mailing Address - Fax:
Practice Address - Street 1:1 N BROADWAY STE 704
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2320
Practice Address - Country:US
Practice Address - Phone:516-359-8150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023818103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical