Individual
CYNTHIA VIRTS WICKLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
196 CONANTVILLE RD, MANSFIELD CENTER, CT 06250-0114
(860) 456-2793
Mailing address
PO BOX 114, 196 CONANTVILLE RD, MANSFIELD CENTER, CT 06250-0114
(860) 456-2793
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001515
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060001515CT01
BLUE CROSS BLUE SHIELD
—
Enumeration date
09/22/2006
Last updated
07/08/2007
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