Provider Demographics
NPI:1225515711
Name:WILKENS, CARRIE L (PHD)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:WILKENS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONE MANOR DR
Mailing Address - Street 2:
Mailing Address - City:NEW MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01230-9744
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:276 5TH AVE RM 1101
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4544
Practice Address - Country:US
Practice Address - Phone:212-683-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014881103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical