Nic Wildes, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

6217 Issued in MA

Practice address

12 Sewall Ave
Brookline, MA 02446-5102

Phone

(617) 203-7082

NPI assigned

Feb 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Nicole Marie Wildes Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective May 26, 2025 through May 26, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sayftee

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Brookline, MA
  • NPI 1942778923
  NPD Authorized official

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1881732618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1321",
            "city": "EASTHAMPTON",
            "state": "MA",
            "postal_code": "010275321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 SEWALL AVE",
            "city": "BROOKLINE",
            "state": "MA",
            "postal_code": "024465102",
            "telephone_number": "617-203-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDES",
        "first_name": "NIC",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-02",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "6217",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "WILDES",
            "middle_name": "MARIE",
            "credential": "LMHC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Daniel Maurice Whiteman, D.M.D.
• John Whooley, DPT
• Donna Elizabeth Wiejkus, PHYSICAL THERAPIST
• Danielle Torre Wiggins
• Nechama J Wildanah, CPM
• William E. Goldberg, M.D., P.C.
• Alexa Williams, MFT
• Joseph J Williams, DDS
• Lauren Tecce Williams, PT, DPT
• Sarah Williamson

• Mental Health Counselor in Brookline, MA
• Providers in Brookline, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.