Provider Demographics
NPI:1285164418
Name:WALD, EMILY LAUREN (PHD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:LAUREN
Last Name:WALD
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 SW 135TH DR
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7048
Mailing Address - Country:US
Mailing Address - Phone:305-431-0002
Mailing Address - Fax:
Practice Address - Street 1:1390 S DIXIE HWY STE 1305
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2974
Practice Address - Country:US
Practice Address - Phone:305-431-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06154103T00000X
FLPY10880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist