Healthcare Provider Details

I. General information

NPI: 1003604935
Provider Name (Legal Business Name): MAEGAN LILLIAN WILD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1073 N BENSON RD
FAIRFIELD CT
06824-5171
US

IV. Provider business mailing address

149 BEACON MANOR RD
NAUGATUCK CT
06770-4914
US

V. Phone/Fax

Practice location:
  • Phone: 203-254-4000
  • Fax:
Mailing address:
  • Phone: 203-915-3074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: