Provider Demographics
NPI:1316486806
Name:WILCHES, NADINE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:
Last Name:WILCHES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:BOSSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 N MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-2582
Mailing Address - Country:US
Mailing Address - Phone:631-339-0852
Mailing Address - Fax:
Practice Address - Street 1:196 N MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782
Practice Address - Country:US
Practice Address - Phone:631-339-0852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA697581041C0700X
NY0847991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical