Provider Demographics
NPI:1114199940
Name:WILCOX, JUDITH DALE (EDD,NCC,LPC)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:DALE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:EDD,NCC,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 CHIDSEY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06471-1269
Mailing Address - Country:US
Mailing Address - Phone:203-483-3140
Mailing Address - Fax:
Practice Address - Street 1:61 CHIDSEY DR
Practice Address - Street 2:
Practice Address - City:NORTH BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06471-1269
Practice Address - Country:US
Practice Address - Phone:203-483-3140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional