Provider Demographics
NPI:1629893748
Name:WILDE, EMMA JAMES (LMHC)
Entity type:Individual
Prefix:MS
First Name:EMMA
Middle Name:JAMES
Last Name:WILDE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 GELSTON AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7012
Mailing Address - Country:US
Mailing Address - Phone:646-250-3664
Mailing Address - Fax:
Practice Address - Street 1:179 GELSTON AVE APT 2D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7012
Practice Address - Country:US
Practice Address - Phone:646-250-3664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015437101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health