Provider Demographics
NPI:1649498536
Name:WUNDERMAN, OREN DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:OREN
Middle Name:DAVID
Last Name:WUNDERMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SOUTHWEST 57TH. AVE.
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:786-236-0573
Mailing Address - Fax:305-385-6174
Practice Address - Street 1:7600 SOUTHWEST 57TH AVE.
Practice Address - Street 2:SUITE 222
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:786-236-0573
Practice Address - Fax:305-385-7164
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3862103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPY3862OtherPSYCHOLOGIST
FLMT716OtherMARRIAGE & FAMILY THERAPI
FLMH255OtherMENTAL HEALTH COUNSELOR