Basic Information
| Provider Information | |||||||||
| NPI: | 1831282128 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WICHROWSKI | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW-R | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1134 STATE ROUTE 29 | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128346107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186929861 | ||||||||
| FaxNumber: | 5186927947 | ||||||||
| Practice Location | |||||||||
| Address1: | 1134 STATE ROUTE 29 | ||||||||
| Address2: | |||||||||
| City: | GREENWICH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128346107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186929861 | ||||||||
| FaxNumber: | 5186927947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 02/17/2015 | ||||||||
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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 | 1041C0700X | 037572 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.