Provider Demographics
NPI:1255702221
Name:AMY D WICKER PSY D PLLC
Entity type:Organization
Organization Name:AMY D WICKER PSY D PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:WICKER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:212-405-2685
Mailing Address - Street 1:26 COURT ST STE 409
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1134
Mailing Address - Country:US
Mailing Address - Phone:212-405-2685
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 409
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1134
Practice Address - Country:US
Practice Address - Phone:212-405-2685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-15
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty