Provider Demographics
NPI:1649483561
Name:WIELICZKO, JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:WIELICZKO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 GAYLE DR
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-5620
Mailing Address - Country:US
Mailing Address - Phone:215-321-0656
Mailing Address - Fax:
Practice Address - Street 1:513 GAYLE DR
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067-5620
Practice Address - Country:US
Practice Address - Phone:215-321-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008404L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical