Provider Demographics
NPI:1497197784
Name:WILKINSON- BROWN, CHARMAINE ANDREA (MSED, SPECED)
Entity Type:Individual
Prefix:MRS
First Name:CHARMAINE
Middle Name:ANDREA
Last Name:WILKINSON- BROWN
Suffix:
Gender:F
Credentials:MSED, SPECED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 IRVING ST S
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2340
Mailing Address - Country:US
Mailing Address - Phone:516-285-0391
Mailing Address - Fax:
Practice Address - Street 1:1145 IRVING ST S
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2340
Practice Address - Country:US
Practice Address - Phone:516-285-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71854131103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities