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General NPI Number Information
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NPI Number | 1427952084
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Entity Type | Individual
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Provider Name | AIDAN JARED WIGHTMAN LMSW
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Gender | Male
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Dates
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Enumeration Date | 10/06/2026
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Last Update Date | 10/06/2026
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Provider Practice Location Address
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Address Line | 7555 MAIN RD
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City | MATTITUCK
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State | NY
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Zip | 11952-1516
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Country | US
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Telephone | 631-298-8642
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Fax |
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Provider Business Mailing Address
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Address Line | 98 WATERVIEW DR
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City | SOUND BEACH
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State | NY
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Zip | 11789-1034
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Country | US
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Telephone | 631-697-9711
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 133311
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License Number State | NY
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