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General NPI Number Information
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NPI Number | 1437500865
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Entity Type | Individual
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Provider Name | AMBER WICELINSKI
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Gender | Female
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Dates
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Enumeration Date | 06/27/2016
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Last Update Date | 06/11/2020
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Provider Practice Location Address
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Address Line | 34 SCHOOL ST STE 104
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City | FOXBORO
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State | MA
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Zip | 02035-2318
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Country | US
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Telephone | 781-355-6534
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 749
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City | HAWLEYVILLE
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State | CT
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Zip | 06440-0749
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Country | US
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Telephone |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 121220
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License Number State | MA
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