Individual
MARCELLA WIJAYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1651 3RD AVE, SUITE 205, NEW YORK, NY 10128
(212) 427-7070
Mailing address
1651 3RD AVE, SUITE 205, NEW YORK, NY 10128
Taxonomy
Speciality
Code
Description
License number
State
102L00000X
Psychoanalyst
Primary
001099-01
NY
Other
Enumeration date
09/14/2021
Last updated
09/14/2021
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