Provider Demographics
NPI:1992231187
Name:WICKARD, PAGET BRIDGET (PSYD)
Entity type:Individual
Prefix:MRS
First Name:PAGET
Middle Name:BRIDGET
Last Name:WICKARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:PAGET
Other - Middle Name:
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:827 CRAWFORD RUN RD
Mailing Address - Street 2:
Mailing Address - City:CHESWICK
Mailing Address - State:PA
Mailing Address - Zip Code:15024-2423
Mailing Address - Country:US
Mailing Address - Phone:412-245-6145
Mailing Address - Fax:
Practice Address - Street 1:DORSEYVILLE ALLIANCE CHURCH 3703 SAXONBURG BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238
Practice Address - Country:US
Practice Address - Phone:412-423-5802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-07
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018543103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist