Provider Demographics
NPI:1003072653
Name:WICKER, NATALIE L (LMSW, LADC)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:L
Last Name:WICKER
Suffix:
Gender:F
Credentials:LMSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 S MAIN ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3110
Mailing Address - Country:US
Mailing Address - Phone:203-440-9975
Mailing Address - Fax:203-440-9288
Practice Address - Street 1:600 EAST ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2132
Practice Address - Country:US
Practice Address - Phone:203-440-9975
Practice Address - Fax:203-440-9288
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235918Medicaid