Provider Demographics
NPI:1659421055
Name:TOLK, TERRY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:TOLK
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 1:151 W 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3401
Mailing Address - Country:US
Mailing Address - Phone:212-362-1750
Mailing Address - Fax:212-787-2269
Practice Address - Street 1:151 W 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3401
Practice Address - Country:US
Practice Address - Phone:212-362-1750
Practice Address - Fax:212-787-2269
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010628103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01283352Medicaid
NY01283352Medicaid