Provider Demographics
NPI:1467097279
Name:JEAN PAO WILSON, PH,D., LLC
Entity Type:Organization
Organization Name:JEAN PAO WILSON, PH,D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:YUN
Authorized Official - Last Name:PAO WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:413-307-4777
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:EASTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-5016
Mailing Address - Country:US
Mailing Address - Phone:413-307-4777
Mailing Address - Fax:
Practice Address - Street 1:247 NORTHAMPTON ST STE 7
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1052
Practice Address - Country:US
Practice Address - Phone:413-307-4777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-15
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)