Provider Demographics
NPI:1760044606
Name:WILLICK, STEVEN (PSYD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:WILLICK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SIMCHA
Other - Middle Name:
Other - Last Name:WILLICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:100 ALBION ST
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-2604
Mailing Address - Country:US
Mailing Address - Phone:973-919-6619
Mailing Address - Fax:
Practice Address - Street 1:100 ALBION ST
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-2604
Practice Address - Country:US
Practice Address - Phone:973-919-6619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00374800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ35SI00374800OtherNJ BOARD OF PSYCHOLOGICAL EXAMINERS