Healthcare Provider Details

I. General information

NPI: 1336010669
Provider Name (Legal Business Name): JESSICA PAIGE WILDING-BELALCAZAR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ADMINISTRATION RD
BRIDGEWATER MA
02324-3201
US

IV. Provider business mailing address

80 ROBIN LN
SOMERSET MA
02726-3539
US

V. Phone/Fax

Practice location:
  • Phone: 508-279-4500
  • Fax:
Mailing address:
  • Phone: 774-319-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: