Provider Demographics
NPI:1871861807
Name:WAYNE, LINDA C
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:WAYNE
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 1:175 E 96TH ST
Mailing Address - Street 2:21R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6200
Mailing Address - Country:US
Mailing Address - Phone:917-940-8686
Mailing Address - Fax:
Practice Address - Street 1:175 E 96TH ST
Practice Address - Street 2:21R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6200
Practice Address - Country:US
Practice Address - Phone:917-940-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000185102L00000X
NY194736-1163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult