MEDICARE: DR. JAMI WILDER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSO1419	RI

General Provider Information

NPI Number	:	1891125167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMI WILDER PSY.D.

Provider Business Mailing Address
First Line	:	228 DARTMOUTH WOODS DR
Second Line	:
City	:	DARTMOUTH
State	:	MA
Zip	:	02747-5116
Country	:	US
Telephone Number	:	513-404-1122
Fax Number	:

Provider Business Practice Location Address
First Line	:	63 SOCKANOSSET CROSS RD
Second Line	:	SUITE 2A7
City	:	CRANSTON
State	:	RI
Zip	:	02920-5557
Country	:	US
Telephone Number	:	401-406-1101
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	11/22/2013

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