Provider Demographics
NPI:1518959592
Name:WILKINS, CHARLOTTE E (LCSW)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:E
Last Name:WILKINS
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 1:1477 PARK ST
Mailing Address - Street 2:SUITE 14
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2235
Mailing Address - Country:US
Mailing Address - Phone:860-402-9333
Mailing Address - Fax:860-499-5477
Practice Address - Street 1:1477 PARK ST
Practice Address - Street 2:SUITE 14
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2235
Practice Address - Country:US
Practice Address - Phone:860-402-9333
Practice Address - Fax:860-499-5477
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0037291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003729OtherLICENSE NUMBER
CT003729OtherLICENSE NUMBER