Provider Demographics
NPI:1982809737
Name:WENDEROFF, ALAN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:J
Last Name:WENDEROFF
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 1:181 PEARSALL DR
Mailing Address - Street 2:1E
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3946
Mailing Address - Country:US
Mailing Address - Phone:914-667-4214
Mailing Address - Fax:
Practice Address - Street 1:181 PEARSALL DR
Practice Address - Street 2:1E
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3946
Practice Address - Country:US
Practice Address - Phone:914-667-4214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015451-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent