Active NPI
Fred G Wicks, PHD
- Psychologist
- Lansdale, PA
National Provider Identifier
1477869188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PS 001732-L
- Practice address
- 1943 Armstrong Dr
Lansdale, PA 19446-5669 - Phone
- (215) 699-2437
- Fax
- (215) 699-7681
- NPI assigned
- Aug 19, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS 001732-L | PA | Primary |
Addresses
Primary practice location
1943 Armstrong Dr
Lansdale, PA 19446-5669
Mailing address
1943 Armstrong Dr
Lansdale, PA 19446-5669
Phone (215) 699-2437
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000029388 | Other | PA | HIGHMARK BLUE SHIELD |
| PO 27868 | Other | PA | ADMINISTAR DEFENSE SERVICES |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS 001732-L | PA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282176000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282176000000",
"number": "1477869188",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1943 ARMSTRONG DR",
"city": "LANSDALE",
"state": "PA",
"postal_code": "194465669",
"telephone_number": "215-699-2437",
"fax_number": "215-699-7681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1943 ARMSTRONG DR",
"city": "LANSDALE",
"state": "PA",
"postal_code": "194465669",
"telephone_number": "215-699-2437",
"fax_number": "215-699-7681"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WICKS",
"first_name": "FRED",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-19",
"last_updated": "2010-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "PA",
"license": "PS 001732-L",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK BLUE SHIELD",
"identifier": "000029388",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ADMINISTAR DEFENSE SERVICES",
"identifier": "PO 27868",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lansdale, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.