Provider Demographics
NPI:1174894505
Name:WYLIE, NATHANIEL J SR (LMSW)
Entity type:Individual
Prefix:MR
First Name:NATHANIEL
Middle Name:J
Last Name:WYLIE
Suffix:SR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 THE PLZ
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-2639
Mailing Address - Country:US
Mailing Address - Phone:518-881-2044
Mailing Address - Fax:
Practice Address - Street 1:1445 THE PLZ
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2639
Practice Address - Country:US
Practice Address - Phone:518-881-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool