Provider Demographics
NPI:1104266154
Name:WILCOX, AVIVA S (PSYD)
Entity type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:S
Last Name:WILCOX
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27196
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-0196
Mailing Address - Country:US
Mailing Address - Phone:510-467-0320
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 27196
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-0196
Practice Address - Country:US
Practice Address - Phone:510-467-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020137103TC0700X
MA9723103TC0700X
CA27568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical