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General NPI Number Information
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NPI Number | 1649042078
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Entity Type | Organization
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Legal Business Name | EMILY WYCKOFF LLC
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Dates
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Enumeration Date | 10/30/2023
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 1 WILDWOOD RD
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City | VERNON ROCKVILLE
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State | CT
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Zip | 06066-6013
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Country | US
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Telephone | 860-375-0470
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WILDWOOD RD
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City | VERNON
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State | CT
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Zip | 06066-6013
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Country | US
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Telephone | 860-375-0470
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. EMILY P WYCKOFF
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Credential | PHD
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Telephone | 860-375-0475
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | NULL
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