Provider Demographics
NPI:1790904837
Name:WOLKIN, JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:WOLKIN
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 1:1225 PARK AVE
Mailing Address - Street 2:APT. 10D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1758
Mailing Address - Country:US
Mailing Address - Phone:212-831-4667
Mailing Address - Fax:212-831-4667
Practice Address - Street 1:1225 PARK AVE
Practice Address - Street 2:APT. 10D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1758
Practice Address - Country:US
Practice Address - Phone:212-831-4667
Practice Address - Fax:212-831-4667
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008765-1103TC0700X, 103TH0004X
NJSI0-2296103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV4A081Medicare ID - Type Unspecified
NJ037988Medicare ID - Type Unspecified