Provider Demographics
NPI:1275757890
Name:WACHS, CAROL
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:WACHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:
Other - Last Name:WACHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYCHOLOGIST
Mailing Address - Street 1:39 5TH AVE
Mailing Address - Street 2:1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4339
Mailing Address - Country:US
Mailing Address - Phone:212-254-4778
Mailing Address - Fax:
Practice Address - Street 1:39 5TH AVE
Practice Address - Street 2:1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4339
Practice Address - Country:US
Practice Address - Phone:212-254-4778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010430103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist