Healthcare Provider Details

I. General information

NPI: 1407693252
Provider Name (Legal Business Name): THE WILDLING CIRCLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 PLEASANT ST
OXFORD ME
04270-4273
US

IV. Provider business mailing address

14 SKYLINE DR UNIT 12
FISHKILL NY
12524-3645
US

V. Phone/Fax

Practice location:
  • Phone: 973-229-8224
  • Fax:
Mailing address:
  • Phone:
  • 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: LAURA PALERMO
Title or Position: OWNER/ LCSW
Credential: LCSW
Phone: 973-229-8224