Provider Demographics
NPI:1447651989
Name:VAYSMAN, RENATA (PHD)
Entity type:Individual
Prefix:DR
First Name:RENATA
Middle Name:
Last Name:VAYSMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2925 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2501
Mailing Address - Country:US
Mailing Address - Phone:718-616-6034
Mailing Address - Fax:718-616-5694
Practice Address - Street 1:2925 W 19TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224
Practice Address - Country:US
Practice Address - Phone:718-616-6034
Practice Address - Fax:718-616-5694
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2025-01-29
Deactivation Date:2024-07-17
Deactivation Code:
Reactivation Date:2025-01-29
Provider Licenses
StateLicense IDTaxonomies
NY22124103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02449154OtherMEDICAD #
NY1285628552OtherAGENCY
NYWVE061OtherMEDICARE #