Provider Demographics
NPI:1679029193
Name:KAREN WOLMAN, PSY.D.
Entity Type:Organization
Organization Name:KAREN WOLMAN, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:407-493-4045
Mailing Address - Street 1:PO BOX 2363
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-2363
Mailing Address - Country:US
Mailing Address - Phone:407-493-4045
Mailing Address - Fax:918-401-8648
Practice Address - Street 1:6645 VINELAND RD
Practice Address - Street 2:SUITE 270
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-7841
Practice Address - Country:US
Practice Address - Phone:407-493-4045
Practice Address - Fax:918-401-8648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6288103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54639ZMedicare PIN