Provider Demographics
NPI:1467407015
Name:WALDMAN, PENNI NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENNI
Middle Name:NICOLE
Last Name:WALDMAN
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 1:5 SADORE LN
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-4753
Mailing Address - Country:US
Mailing Address - Phone:914-961-8412
Mailing Address - Fax:914-961-8412
Practice Address - Street 1:153 MAIN ST
Practice Address - Street 2:SUITE F-5
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2317
Practice Address - Country:US
Practice Address - Phone:914-961-8412
Practice Address - Fax:914-961-8412
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0154791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM3691OtherMEDICARE
NY02410584Medicaid
NYVM3691OtherMEDICARE