Mary Izzo Wight, PMHNP, RN, BSN, LAC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

403071 Issued in NY

Practice address

1630 E 15TH St FL 2
Brooklyn, NY 11229-1193

Phone

(646) 477-3779

Fax

(914) 220-4231

NPI assigned

Jan 3, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603238400000",
    "number": "1740347095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "229 E 8TH ST # 3",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112183303",
            "telephone_number": "718-483-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 E 15TH ST FL 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112291193",
            "telephone_number": "646-477-3779",
            "fax_number": "914-220-4231"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 E 8th St # 3",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112183303",
            "country_code": "US",
            "telephone_number": "718-483-5515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIGHT",
        "first_name": "MARY",
        "middle_name": "IZZO",
        "name_prefix": "Ms.",
        "credential": "PMHNP, RN, BSN, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2020-10-21",
        "certification_date": "2020-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "664500",
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NY",
            "license": "25003048",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "403071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clifford Robert Wigdor, DPM
• Michelle Renee Wigdzinski, M.A.,CCC-SLP
• Elizabeth J Wiggins, RN
• Nicole Evelyn Wiggins, RN
• Shakima Wiggins, CNM, IBCLC, LCCE
• Courtney Wiginton
• Wigmedinc
• Wiiliamsburg Podiatry Foot Care P.C
• Chaya B. Wikler
• Marvin E Wikler, DSW LCSW

• Psychiatric/Mental Health Nurse Practitioner in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.