Provider Demographics
NPI:1033572714
Name:WILSEY, HEATHER ANNE (CASAC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANNE
Last Name:WILSEY
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:SAVASTANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CASAC
Mailing Address - Street 1:52 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1141
Mailing Address - Country:US
Mailing Address - Phone:315-876-6842
Mailing Address - Fax:315-682-3856
Practice Address - Street 1:52 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1141
Practice Address - Country:US
Practice Address - Phone:315-876-6842
Practice Address - Fax:315-682-3856
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29197101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)