Provider Demographics
NPI:1437457207
Name:WILSON- OWENS, KIM W (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KIM
Middle Name:W
Last Name:WILSON- OWENS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 GARDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-2016
Mailing Address - Country:US
Mailing Address - Phone:914-699-2686
Mailing Address - Fax:
Practice Address - Street 1:410 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-2016
Practice Address - Country:US
Practice Address - Phone:914-699-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP027341-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical