Provider Demographics
NPI:1871806380
Name:WILTSHIRE, MICHELLE CARITTA (PSYD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CARITTA
Last Name:WILTSHIRE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 LINCOLN BLVD
Mailing Address - Street 2:APT 3312
Mailing Address - City:MIDDLESEX
Mailing Address - State:NJ
Mailing Address - Zip Code:08846-1060
Mailing Address - Country:US
Mailing Address - Phone:858-207-7364
Mailing Address - Fax:
Practice Address - Street 1:220 5TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7708
Practice Address - Country:US
Practice Address - Phone:858-207-7364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021478103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical