Active NPI
Maya A. Wilder, MLIS, MS, LMHC, NCC
- Mental Health Counselor
- New York, NY
National Provider Identifier
1942965991
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 014512
- Practice address
- 500 8TH Ave
Front 3 #1778
New York, NY 10018 - Phone
- (631) 482-7378
- NPI assigned
- Nov 4, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 014512 | NY | Primary |
Addresses
Primary practice location
500 8TH Ave
Front 3 #1778
New York, NY 10018
Mailing address
500 8TH Ave
Front 3 #1778
New York, NY 10018
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 11, 2024 through Nov 11, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014512 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719964800000",
"number": "1942965991",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 8TH AVE",
"address_2": "FRONT 3 #1778",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10018"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 8TH AVE",
"address_2": "FRONT 3 #1778",
"city": "NEW YORK",
"state": "NY",
"postal_code": "10018",
"telephone_number": "631-482-7378"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILDER",
"first_name": "MAYA",
"middle_name": "A.",
"name_prefix": "Mrs.",
"credential": "MLIS, MS, LMHC, NCC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-11-04",
"last_updated": "2024-07-03",
"certification_date": "2024-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "014512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2024; 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.