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NPI Code Detail

MEDICARE: VICTORIA WICKLES

MEDICARE: VICTORIA WICKLES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1457641821
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA WICKLES
Provider Business Mailing Address
First Line : PO BOX 4219
Second Line :
City : PITTSFIELD
State : MA
Zip : 01202-4219
Country : US
Telephone Number : 413-629-1262
Fax Number : 413-448-2198
Provider Business Practice Location Address
First Line : 359 FENN ST
Second Line :
City : PITTSFIELD
State : MA
Zip : 01201-5261
Country : US
Telephone Number : 413-629-1262
Fax Number : 413-448-2198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2011
Last Update Date : 04/19/2011

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Directions to “ VICTORIA WICKLES ” Practice Location

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