Provider Demographics
NPI:1194855510
Name:WU, TONY (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:WU
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 S. VALEVIEW DR.
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765
Mailing Address - Country:US
Mailing Address - Phone:909-753-4986
Mailing Address - Fax:888-815-0483
Practice Address - Street 1:1422 S. VALEVIEW DR.
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765
Practice Address - Country:US
Practice Address - Phone:909-753-4986
Practice Address - Fax:888-815-0483
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21093103T00000X
IN20042101A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist