Provider Demographics
NPI:1992506430
Name:WILDMAN, CLARISSA (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:WILDMAN
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CRIS
Other - Middle Name:
Other - Last Name:WILDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:546 HAMIL RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:PA
Mailing Address - Zip Code:15147-2958
Mailing Address - Country:US
Mailing Address - Phone:614-205-1036
Mailing Address - Fax:
Practice Address - Street 1:2345 MURRAY AVE STE 305
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2352
Practice Address - Country:US
Practice Address - Phone:412-376-5017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS020436103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist