Provider Demographics
NPI:1639107998
Name:WILCZAK, PAUL F (PHD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:WILCZAK
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-6340
Mailing Address - Fax:717-851-6349
Practice Address - Street 1:3550 CONCORD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402-8626
Practice Address - Country:US
Practice Address - Phone:717-851-6340
Practice Address - Fax:717-851-6349
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006213L103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA112012000OtherMAGELLAN
PAP00074980OtherRAILROAD MEDICARE
PA1031360OtherCIGNA BEHAV HEALTH
PA064396OtherVALUE OPTIONS
PA131335OtherPA BLUE SHIELD
PA001535250Medicaid
PA434143OtherMAMSI
PA01096501OtherCAPITAL BLUE CROSS
PA112012000OtherMAGELLAN
PA131335OtherPA BLUE SHIELD