Provider Demographics
NPI:1164058699
Name:WALKENFELD, FAYE F (PHD)
Entity Type:Individual
Prefix:DR
First Name:FAYE
Middle Name:F
Last Name:WALKENFELD
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 1:1010 DICKENS ST
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-2407
Mailing Address - Country:US
Mailing Address - Phone:347-225-1603
Mailing Address - Fax:
Practice Address - Street 1:1010 DICKENS ST
Practice Address - Street 2:
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-2407
Practice Address - Country:US
Practice Address - Phone:347-225-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015750103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist