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General NPI Number Information
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NPI Number | 1538290432
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Entity Type | Individual
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Provider Name | CHERYL K WILCZAK PSY.D
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Gender | Female
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 11/17/2013
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Provider Practice Location Address
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Address Line | 406 W PUTNAM AVE
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City | GREENWICH
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State | CT
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Zip | 06830-6215
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Country | US
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Telephone | 203-675-9405
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 WASHINGTON BLVD
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City | STAMFORD
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State | CT
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Zip | 06902-2499
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Country | US
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Telephone | 201-362-9050
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2766
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License Number State | CT
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