Basic Information
| Provider Information | |||||||||
| NPI: | 1669437232 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILIKOFSKY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 555 N DUKE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 176022250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7175445511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2006 | ||||||||
| LastUpdateDate: | 04/12/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PS005455L | PA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 3321658000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER | 0787071000 | 01 | PA | AMERIHEALTH 65 OR IBC | OTHER | HMO# 1150122 | 01 | PA | AETNA | OTHER | 001539956 | 01 | PA | CBHNP | OTHER | 50055747 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 000670444 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0015399560003 | 05 | PA | MEDICAID | 176754000 | 01 | PA | MAGELLAN | OTHER |