Provider Demographics
NPI:1538469952
Name:WILBER, GRETCHEN HERBERT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:HERBERT
Last Name:WILBER
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 1:5 PINE WEST PLAZA
Mailing Address - Street 2:SUITE 511
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205
Mailing Address - Country:US
Mailing Address - Phone:518-719-5551
Mailing Address - Fax:518-536-9022
Practice Address - Street 1:5 PINE WEST PLAZA
Practice Address - Street 2:SUITE 511
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205
Practice Address - Country:US
Practice Address - Phone:518-719-5551
Practice Address - Fax:518-536-9022
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018991103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical