Jewell K Waldbaum, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3934 Issued in NY

Practice address

12 Hawk St
Spring Valley, NY 10977-6104

Phone

(845) 356-6329

Fax

(845) 425-0144

NPI assigned

Jun 24, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1967

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1124024005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 HAWK ST",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109776104",
            "telephone_number": "845-356-6329",
            "fax_number": "845-425-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 HAWK ST",
            "city": "SPRING VALLEY",
            "state": "NY",
            "postal_code": "109776104",
            "telephone_number": "845-356-6329",
            "fax_number": "845-425-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDBAUM",
        "first_name": "JEWELL",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-06-24",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "3934",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NY",
            "license": "3934",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NY",
            "license": "3934",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI IDENTIFICATION NUMBER",
            "identifier": "0081767",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "3934",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shterna Sarah Vogel
• Emmanuella Volcy
• Frantz Wackmann, LPN
• Ruth G Wackmann, LPN
• Ephraim Wakszul, PA
• Walgreen Co
• Hannah Walkin
• Teresa Wallace
• Sury Warfman
• Aliza Warum

• Clinical Psychologist in Spring Valley, NY
• Providers in Spring Valley, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.