Provider Demographics
NPI:1023859816
Name:WILDMAN FOSTER, JESSE MCGRAW (LMFT)
Entity type:Individual
Prefix:MRS
First Name:JESSE
Middle Name:MCGRAW
Last Name:WILDMAN FOSTER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 W 181ST ST APT 24
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4454
Mailing Address - Country:US
Mailing Address - Phone:703-863-7755
Mailing Address - Fax:703-863-7755
Practice Address - Street 1:870 W 181ST ST APT 24
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4454
Practice Address - Country:US
Practice Address - Phone:703-863-7755
Practice Address - Fax:703-863-7755
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002290106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist