Provider Demographics
NPI:1487218541
Name:WILKES, CAROLINE DORA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:DORA
Last Name:WILKES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 WALNUT ST APT 1610
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4959
Mailing Address - Country:US
Mailing Address - Phone:267-258-2489
Mailing Address - Fax:
Practice Address - Street 1:3400 MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3306
Practice Address - Country:US
Practice Address - Phone:267-258-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist