Provider Demographics
NPI:1023218195
Name:WALDMAN, CLIFFORD SCOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:SCOTT
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WASHINGTON PL
Mailing Address - Street 2:GARDEN APARTMENT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6819
Mailing Address - Country:US
Mailing Address - Phone:212-807-1637
Mailing Address - Fax:212-807-1637
Practice Address - Street 1:126 WASHINGTON PL
Practice Address - Street 2:GARDEN APARTMENT
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6819
Practice Address - Country:US
Practice Address - Phone:212-807-1637
Practice Address - Fax:212-807-1637
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6842-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02515199Medicaid
NY4276616OtherAETNA
NY4276616OtherAETNA