Provider Demographics
NPI:1144654781
Name:WOLFSON, DANIEL (PSYD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:WOLFSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E 64TH ST APT 16S
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7509
Mailing Address - Country:US
Mailing Address - Phone:617-838-0311
Mailing Address - Fax:
Practice Address - Street 1:340 E 64TH ST APT 16S
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7509
Practice Address - Country:US
Practice Address - Phone:617-838-0311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-31
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY022265103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program