Provider Demographics
NPI:1487673844
Name:WILDER, ANN CATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:CATHERINE
Last Name:WILDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 VANCE AVE
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-2130
Mailing Address - Country:US
Mailing Address - Phone:325-271-8707
Mailing Address - Fax:
Practice Address - Street 1:UPMC PAIN MEDICINE
Practice Address - Street 2:UPMC ST. MARGARET'S HOSPITAL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215
Practice Address - Country:US
Practice Address - Phone:412-784-5119
Practice Address - Fax:412-784-5228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX361571041C0700X
PACW0209521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163974202Medicaid
TX86477QOtherBLUE CROSS BLUE SHEILD
TXP00144488OtherRAIL ROAD