Provider Demographics
NPI:1548421027
Name:WIDRICK, CARYN S (MT-BC)
Entity Type:Individual
Prefix:MS
First Name:CARYN
Middle Name:S
Last Name:WIDRICK
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 KNIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-4242
Mailing Address - Country:US
Mailing Address - Phone:215-637-2077
Mailing Address - Fax:215-637-2079
Practice Address - Street 1:10700 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4242
Practice Address - Country:US
Practice Address - Phone:215-637-2077
Practice Address - Fax:215-637-2079
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor