Provider Demographics
NPI:1578056412
Name:WILKINSON, JESSIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:WILKINSON
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 1:20 MEDFORD AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1220
Mailing Address - Country:US
Mailing Address - Phone:347-779-1186
Mailing Address - Fax:
Practice Address - Street 1:20 MEDFORD AVE STE 110
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1220
Practice Address - Country:US
Practice Address - Phone:473-779-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0870201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical