Provider Demographics
NPI:1447482518
Name:WILDER, FERD (MSW)
Entity type:Individual
Prefix:MR
First Name:FERD
Middle Name:
Last Name:WILDER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:CHIP
Other - Middle Name:
Other - Last Name:WILDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:142 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1212
Mailing Address - Country:US
Mailing Address - Phone:508-376-6018
Mailing Address - Fax:508-485-8807
Practice Address - Street 1:142 EXCHANGE ST
Practice Address - Street 2:
Practice Address - City:MILLIS
Practice Address - State:MA
Practice Address - Zip Code:02054-1212
Practice Address - Country:US
Practice Address - Phone:508-376-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1027681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical