Provider Demographics
NPI:1669437232
Name:WILIKOFSKY, ADAM (PHD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:WILIKOFSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N DUKE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2250
Mailing Address - Country:US
Mailing Address - Phone:717-544-5511
Mailing Address - Fax:
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-544-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005455L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3321658000OtherINDEPENDENCE BLUE CROSS
PA0787071000OtherAMERIHEALTH 65 OR IBC
PAHMO# 1150122OtherAETNA
PA001539956OtherCBHNP
PA50055747OtherCAPITAL BLUE CROSS
PA000670444OtherHIGHMARK BLUE SHIELD
PA0015399560003Medicaid
PA176754000OtherMAGELLAN
PA0015399560003Medicaid