Provider Demographics
NPI:1679908594
Name:WIEDERHORN, JOANNA
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:WIEDERHORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 FULTON ST RM 901
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2531
Mailing Address - Country:US
Mailing Address - Phone:646-450-3602
Mailing Address - Fax:
Practice Address - Street 1:139 FULTON ST RM 901
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2531
Practice Address - Country:US
Practice Address - Phone:646-379-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker