Provider Demographics
NPI:1558616383
Name:WULFSOHN, SAMANTHA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:WULFSOHN
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 1:10 W END AVE
Mailing Address - Street 2:12K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7826
Mailing Address - Country:US
Mailing Address - Phone:773-308-5203
Mailing Address - Fax:
Practice Address - Street 1:10 W END AVE
Practice Address - Street 2:12K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7826
Practice Address - Country:US
Practice Address - Phone:773-308-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018890103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist