Provider Demographics
NPI:1922737477
Name:WILCOCKS, CHELSEA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:
Last Name:WILCOCKS
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 1:3015 N OCEAN BLVD STE C107
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7301
Mailing Address - Country:US
Mailing Address - Phone:954-870-2739
Mailing Address - Fax:
Practice Address - Street 1:3015 N OCEAN BLVD STE C107
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-7301
Practice Address - Country:US
Practice Address - Phone:954-870-2739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11275103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical