Provider Demographics
NPI:1124265244
Name:WULF, JESSICA (PHD)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:WULF
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 1:9 NATHAN D PERLMAN PL
Mailing Address - Street 2:6 BERNSTEIN 6B40C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3801
Mailing Address - Country:US
Mailing Address - Phone:212-420-3846
Mailing Address - Fax:212-674-3828
Practice Address - Street 1:9 NATHAN D PERLMAN PL
Practice Address - Street 2:6 BERNSTEIN 6B40C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3801
Practice Address - Country:US
Practice Address - Phone:212-420-3846
Practice Address - Fax:212-674-3828
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0173261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical