Provider Demographics
NPI:1689895468
Name:WALD, LOIS ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LOIS
Middle Name:ELLEN
Last Name:WALD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6614
Mailing Address - Country:US
Mailing Address - Phone:203-629-8788
Mailing Address - Fax:
Practice Address - Street 1:66 MILTON RD
Practice Address - Street 2:SUITE G-12
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3850
Practice Address - Country:US
Practice Address - Phone:914-921-3951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011498-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist