Provider Demographics
NPI:1447586318
Name:PSYCHOLOGIST ON WHEELS PC
Entity Type:Organization
Organization Name:PSYCHOLOGIST ON WHEELS PC
Other - Org Name:CHILD AND FAMILY PSYCHOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAUSELLE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:516-750-4841
Mailing Address - Street 1:393 FRANKLIN AVE
Mailing Address - Street 2:101
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1222
Mailing Address - Country:US
Mailing Address - Phone:516-750-4841
Mailing Address - Fax:516-394-4767
Practice Address - Street 1:393 FRANKLIN AVE
Practice Address - Street 2:101
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1222
Practice Address - Country:US
Practice Address - Phone:516-750-4841
Practice Address - Fax:516-394-4767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty