Provider Demographics
NPI:1760712640
Name:WILDRICK, NANCY HILL (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:HILL
Last Name:WILDRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 37TH ST FL 5
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4252
Mailing Address - Country:US
Mailing Address - Phone:908-681-4270
Mailing Address - Fax:
Practice Address - Street 1:320 W 37TH ST FL 5
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4252
Practice Address - Country:US
Practice Address - Phone:908-681-4270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW54751041C0700X
FLMA 52361174400000X
NJ18KT00779400225700000X
NJ44SC056445001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No174400000XOther Service ProvidersSpecialist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist