Provider Demographics
NPI:1508521493
Name:WILKINSON, TAMARA L (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:L
Other - Last Name:WILKINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:155 THURTON DR
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6013
Mailing Address - Country:US
Mailing Address - Phone:203-249-0201
Mailing Address - Fax:
Practice Address - Street 1:208 VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-3899
Practice Address - Country:US
Practice Address - Phone:203-801-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6122104100000X
CT135301041C0700X
NY115435104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13530OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH
CT6122OtherCONNECTICUT DEPARTMENT OF PUBLIC HEALTH
NY115435OtherSTATE OF NY EDUCATION DEPARTMENT