Individual
MR. MELVYN WILDER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
116 JOHN ST FL 27, NEW YORK, NY 10038-3414
(212) 964-0128
(212) 964-0113
Mailing address
116 JOHN ST FL 27, NEW YORK, NY 10038-3414
(212) 964-0128
(212) 964-0113
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
18224
NY
Other
Enumeration date
03/19/2009
Last updated
10/29/2010
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