Provider Demographics
NPI:1497876759
Name:WIKLER, MARVIN E (DSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:E
Last Name:WIKLER
Suffix:
Gender:M
Credentials:DSW LCSW
Other - Prefix:DR
Other - First Name:MEIR
Other - Middle Name:E
Other - Last Name:WIKLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DSW LCSW
Mailing Address - Street 1:4713 17TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204
Mailing Address - Country:US
Mailing Address - Phone:718-438-6529
Mailing Address - Fax:718-438-6529
Practice Address - Street 1:4713 17TH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204
Practice Address - Country:US
Practice Address - Phone:718-438-6529
Practice Address - Fax:718-438-6529
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0138611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical