Provider Demographics
NPI:1114956455
Name:WERTHEIM, JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:WERTHEIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 43RD ST
Mailing Address - Street 2:#43
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7402
Mailing Address - Country:US
Mailing Address - Phone:212-736-2177
Mailing Address - Fax:
Practice Address - Street 1:600 3RD AVE
Practice Address - Street 2:#265
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1901
Practice Address - Country:US
Practice Address - Phone:212-736-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007675103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00934809Medicaid
NY00934809Medicaid