Individual
MARK WIELGUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
141 DOSORIS LN, GLEN COVE, NY 11542-1225
(516) 676-1100
(516) 579-0216
Mailing address
303 MERRICK RD, SUITE 204, LYNBROOK, NY 11563-2501
(800) 725-6280
(800) 725-6380
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
009602
NY
Other
Enumeration date
10/18/2010
Last updated
10/18/2010
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