Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | MA | |
Y | 103T00000X | Psychologist | MA |
NPI | 1003398066 |
---|---|
Provider Name | Dr. Michele Wick |
First Address | Northampton, MA 01060-2015 |
Second Address | Northampton, MA 01060-2015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2018 |
Last Update Date | 05/09/2018 |