Provider Demographics
NPI:1427092063
Name:WILDMAN, MARY-ELLEN (LMHC)
Entity type:Individual
Prefix:MS
First Name:MARY-ELLEN
Middle Name:
Last Name:WILDMAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COURTHOUSE LN
Mailing Address - Street 2:3
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-1715
Mailing Address - Country:US
Mailing Address - Phone:978-275-9444
Mailing Address - Fax:
Practice Address - Street 1:2 COURTHOUSE LN
Practice Address - Street 2:3
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1715
Practice Address - Country:US
Practice Address - Phone:978-275-9444
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health