Provider Demographics
NPI:1235270257
Name:WAXENBERG, BARBARA ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:ROSE
Last Name:WAXENBERG
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 1:175 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1616
Mailing Address - Country:US
Mailing Address - Phone:212-873-6765
Mailing Address - Fax:
Practice Address - Street 1:175 RIVERSIDE DR
Practice Address - Street 2:14F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1616
Practice Address - Country:US
Practice Address - Phone:212-873-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004560103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV64382Medicare ID - Type Unspecified