Provider Demographics
NPI:1215262084
Name:WUPPERMAN, PEGGILEE (PHD)
Entity type:Individual
Prefix:
First Name:PEGGILEE
Middle Name:
Last Name:WUPPERMAN
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 1:524 W 59TH ST
Mailing Address - Street 2:PSYCHOLOGY, 10.63.20
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1007
Mailing Address - Country:US
Mailing Address - Phone:212-237-8792
Mailing Address - Fax:
Practice Address - Street 1:136 E 57TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-2707
Practice Address - Country:US
Practice Address - Phone:212-237-8792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-845068103T00000X
NY68 018269103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist