Provider Demographics
NPI:1467704833
Name:WU, IWEN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:IWEN
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSY D
Mailing Address - Street 1:5335 212TH ST
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1811
Mailing Address - Country:US
Mailing Address - Phone:718-352-0104
Mailing Address - Fax:718-352-0131
Practice Address - Street 1:5335 212TH ST
Practice Address - Street 2:
Practice Address - City:BAYSIDE HILLS
Practice Address - State:NY
Practice Address - Zip Code:11364-1811
Practice Address - Country:US
Practice Address - Phone:718-352-0104
Practice Address - Fax:718-352-0131
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1764230103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool