Provider Demographics
NPI:1437522349
Name:WILCOX, NATHAN (LICSW)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:WILCOX
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 EUNICE CIR
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4910
Mailing Address - Country:US
Mailing Address - Phone:617-460-4444
Mailing Address - Fax:
Practice Address - Street 1:7 EUNICE CIR
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-4910
Practice Address - Country:US
Practice Address - Phone:617-460-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1183791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical