Provider Demographics
NPI:1073279105
Name:WILLS, SHAWN (TEACHER)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:WILLS
Suffix:
Gender:M
Credentials:TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-3942
Mailing Address - Country:US
Mailing Address - Phone:516-451-7945
Mailing Address - Fax:
Practice Address - Street 1:977 E 88TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-3942
Practice Address - Country:US
Practice Address - Phone:516-451-7945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health