Provider Demographics
NPI:1083244768
Name:WOOLLEN, BYRON (PHD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:
Last Name:WOOLLEN
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 1:928 BROADWAY STE 1100
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-8115
Mailing Address - Country:US
Mailing Address - Phone:212-710-1361
Mailing Address - Fax:
Practice Address - Street 1:928 BROADWAY STE 1100
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-8115
Practice Address - Country:US
Practice Address - Phone:212-710-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012959103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist