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General NPI Number Information
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NPI Number | 1508996331
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Entity Type | Individual
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Provider Name | GEOFFREY MARTIN WYCKOFF PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 1082 TAYLORSVILLE RD SUITE 105
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City | WASHINGTON CROSSING
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State | PA
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Zip | 18977-1305
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Country | US
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Telephone | 267-399-9962
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Fax | 267-392-5236
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Provider Business Mailing Address
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Address Line | 1082 TAYLORSVILLE RD SUITE 105
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City | WASHINGTON CROSSING
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State | PA
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Zip | 18977-1305
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Country | US
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Telephone | 267-399-9962
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Fax | 267-392-5236
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS007870L
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | PS007870L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 35510065400
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License Number State | NJ
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