Provider Demographics
NPI:1841861309
Name:WYNER, RACHEL NAOMI (PHD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:NAOMI
Last Name:WYNER
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 1:130 HEMPSTEAD AVE APT 314
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2153
Mailing Address - Country:US
Mailing Address - Phone:917-680-0142
Mailing Address - Fax:
Practice Address - Street 1:70 E SUNRISE HWY STE 500
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1233
Practice Address - Country:US
Practice Address - Phone:917-680-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024383103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical