Penni Nicole Waldman, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0154791 Issued in NY

Practice address

153 Main St
Suite F-5
Mount Kisco, NY 10549-2317

Phone

(914) 961-8412

Fax

(914) 961-8412

NPI assigned

May 23, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Life Changing Psychological Services,PLLC

  • Clinical Psychologist
  • Mount Kisco, NY
  • NPI 1497709588
  NPD (past) Authorized official
• Hollander Psychological Consulting PC

  • Clinical Psychologist
  • White Plains, NY
  • NPI 1760534481
  NPD (past)

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1467407015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 SADORE LN",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107104753",
            "telephone_number": "914-961-8412",
            "fax_number": "914-961-8412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 MAIN ST",
            "address_2": "SUITE F-5",
            "city": "MOUNT KISCO",
            "state": "NY",
            "postal_code": "105492317",
            "telephone_number": "914-961-8412",
            "fax_number": "914-961-8412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDMAN",
        "first_name": "PENNI",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-23",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "0154791",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "VM3691",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02410584",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aashay Vyas, MD
• Sejal K Vyas, PH.D.
• Eli Wald, CASAC-T
• Leonard A. Wald, M.D.
• Michael Wald
• Walgreen Co
• Ronald Wallach, MD
• Susan Victoria Walton, LCSW
• John J Wang, M.D.
• Carey Wardell

• Clinical Psychologist in Mount Kisco, NY
• Providers in Mount Kisco, 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 Apr 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.