Healthcare Provider Details

I. General information

NPI: 1003072653
Provider Name (Legal Business Name): NATALIE L WICKER LCSW, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BOSTON POST RD
WEST HAVEN CT
06516-2043
US

IV. Provider business mailing address

114 BOSTON POST RD
WEST HAVEN CT
06516-2043
US

V. Phone/Fax

Practice location:
  • Phone: 203-715-9776
  • Fax:
Mailing address:
  • Phone: 203-715-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number011296
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: