Individual
DR. JEWELL K WALDBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
12 HAWK ST, SPRING VALLEY, NY 10977-6104
(845) 356-6329
(845) 425-0144
Mailing address
12 HAWK ST, SPRING VALLEY, NY 10977-6104
(845) 356-6329
(845) 425-0144
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
3934
NY
103TC0700X
Clinical Psychologist
Primary
3934
NY
103TH0100X
Health Service Psychologist
3934
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0081767
GHI IDENTIFICATION NUMBER
—
01
—
3934
NEW YORK STATE LICENSE
NY
Enumeration date
06/24/2005
Last updated
12/09/2010
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