Provider Demographics
NPI:1376861831
Name:M.W. PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:M.W. PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOXSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:330-733-6022
Mailing Address - Street 1:3538 E PRESCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3398
Mailing Address - Country:US
Mailing Address - Phone:330-733-6022
Mailing Address - Fax:
Practice Address - Street 1:717 CANTON RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-2606
Practice Address - Country:US
Practice Address - Phone:330-733-6022
Practice Address - Fax:330-733-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R98713Medicare UPIN