Healthcare Provider Details

I. General information

NPI: 1801829056
Provider Name (Legal Business Name): WILDERNESS SARCHILD M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 NAN KE RAFE PATH
BREWSTER MA
02631-1590
US

IV. Provider business mailing address

196 NAN KE RAFE PATH PO BOX 2034
BREWSTER MA
02631-1590
US

V. Phone/Fax

Practice location:
  • Phone: 508-896-9489
  • Fax: 508-896-9489
Mailing address:
  • Phone: 508-896-9489
  • Fax: 508-896-9489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3403
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number968
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: