Provider Demographics
NPI:1508996331
Name:WYCKOFF, GEOFFREY MARTIN (PHD)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:MARTIN
Last Name:WYCKOFF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 TAYLORSVILLE RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WASHINGTON CROSSING
Mailing Address - State:PA
Mailing Address - Zip Code:18977-1305
Mailing Address - Country:US
Mailing Address - Phone:267-399-9962
Mailing Address - Fax:267-392-5236
Practice Address - Street 1:1082 TAYLORSVILLE RD
Practice Address - Street 2:SUITE 105
Practice Address - City:WASHINGTON CROSSING
Practice Address - State:PA
Practice Address - Zip Code:18977-1305
Practice Address - Country:US
Practice Address - Phone:267-399-9962
Practice Address - Fax:267-392-5236
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PS007870L103T00000X
PAPS007870L103TC2200X
NJ35510065400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001971881OtherHIGHMARK BLUE SHIELD
PA7044367OtherAETNA
PA0236042000OtherPERSONAL CHOICE
PA092332000OtherMAGELLAN
PAQ63396OtherAMERIHEALTH ADMINISTRATOR
PAP1088196OtherOXFORD