Provider Demographics
NPI:1841610904
Name:WIGGILL, RICHARD (LICSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:WIGGILL
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 RUTLAND SQ APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-3116
Mailing Address - Country:US
Mailing Address - Phone:617-249-7307
Mailing Address - Fax:
Practice Address - Street 1:46 RUTLAND SQ APT 2
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-3116
Practice Address - Country:US
Practice Address - Phone:617-249-3707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1208211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical