Provider Demographics
NPI:1508254434
Name:WILSON, CLAIRE ELIZABETH (MS ED, BCBA)
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:
Other - First Name:CLAIRE
Other - Middle Name:
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:25 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1101
Mailing Address - Country:US
Mailing Address - Phone:631-806-0615
Mailing Address - Fax:
Practice Address - Street 1:25 GRANT ST
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1101
Practice Address - Country:US
Practice Address - Phone:631-806-0615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000373251S00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health