Provider Demographics
NPI:1457400459
Name:WADE, ESTELLE B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:B
Last Name:WADE
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:PO BOX 7654
Mailing Address - Street 2:FDR STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10150-7654
Mailing Address - Country:US
Mailing Address - Phone:212-935-1213
Mailing Address - Fax:
Practice Address - Street 1:141 E 55TH ST
Practice Address - Street 2:SUITE 9B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4030
Practice Address - Country:US
Practice Address - Phone:212-935-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4143103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV1761OtherEMPIRE BLUECROSS BLUESHIE
0004481621OtherAETNA
NYV1761OtherEMPIRE BLUECROSS BLUESHIE