Provider Demographics
NPI:1922363779
Name:WALDECKER, CAROLYN (PSYD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:WALDECKER
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 1:575 UNDERHILL BLVD STE 114
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3436
Mailing Address - Country:US
Mailing Address - Phone:516-780-0111
Mailing Address - Fax:516-441-0199
Practice Address - Street 1:575 UNDERHILL BLVD STE 114
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3436
Practice Address - Country:US
Practice Address - Phone:516-780-0111
Practice Address - Fax:516-441-0199
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist