Provider Demographics
NPI:1760077556
Name:WIENICK, JOSH
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:WIENICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 KINGBIRD CT
Mailing Address - Street 2:
Mailing Address - City:THREE BRIDGES
Mailing Address - State:NJ
Mailing Address - Zip Code:08887-2129
Mailing Address - Country:US
Mailing Address - Phone:724-415-5672
Mailing Address - Fax:
Practice Address - Street 1:280 KINGBIRD CT
Practice Address - Street 2:
Practice Address - City:THREE BRIDGES
Practice Address - State:NJ
Practice Address - Zip Code:08887-2129
Practice Address - Country:US
Practice Address - Phone:724-415-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst