Provider Demographics
NPI:1710075650
Name:WIESENFELD, ALAN RICHARD (PHD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RICHARD
Last Name:WIESENFELD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2006
Mailing Address - Country:US
Mailing Address - Phone:732-291-0261
Mailing Address - Fax:732-291-4216
Practice Address - Street 1:3 BEACON HILL RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2006
Practice Address - Country:US
Practice Address - Phone:732-291-0261
Practice Address - Fax:732-291-4216
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1562103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical