Provider Demographics
NPI:1164912671
Name:WILCOX, DAVID KERR (EDD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KERR
Last Name:WILCOX
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-0002
Mailing Address - Country:US
Mailing Address - Phone:781-258-7562
Mailing Address - Fax:
Practice Address - Street 1:55 BRANTWOOD RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02476-8003
Practice Address - Country:US
Practice Address - Phone:781-258-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6336103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty