Provider Demographics
NPI:1497795173
Name:TAUBENFELD, WAYNE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:A
Last Name:TAUBENFELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 SUMMIT TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-6254
Mailing Address - Country:US
Mailing Address - Phone:541-285-1044
Mailing Address - Fax:541-485-7190
Practice Address - Street 1:1317 N BRAND BLVD APT 7
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1969
Practice Address - Country:US
Practice Address - Phone:310-529-8293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18267103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical