Doctor Name: | MS. PATRICIA M WILDE |
NPI Number: | 1023382561 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | 1025507 |
Business Practice Address: | 7 Winn St Suite 203 Woburn, MA - 018012871 |
Business Phone Number: | 7819108328 |
Business Fax Number: | |
Mailing Address: | 95 Middlesex St, WINCHESTER |
State: | MA |
Postal Code: | 018901828 |
Phone Number: | 7819108328 |
Fax Number: | |
NPI Enumeration Date: | 03/01/2012 |
NPI Last Update Date: | 03/01/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 1025507 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |