Provider Demographics
NPI:1891125167
Name:WILDER, JAMI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMI
Middle Name:
Last Name:WILDER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 DARTMOUTH WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-5116
Mailing Address - Country:US
Mailing Address - Phone:513-404-1122
Mailing Address - Fax:
Practice Address - Street 1:63 SOCKANOSSET CROSS RD
Practice Address - Street 2:SUITE 2A7
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-5557
Practice Address - Country:US
Practice Address - Phone:401-406-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-22
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPSO1419103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical