Provider Demographics
NPI:1578712907
Name:WILKOS, SANDRA L
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:WILKOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GRISWOLD ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-2008
Mailing Address - Country:US
Mailing Address - Phone:860-224-5267
Mailing Address - Fax:860-224-5752
Practice Address - Street 1:50 GRISWOLD ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-2008
Practice Address - Country:US
Practice Address - Phone:860-224-5267
Practice Address - Fax:860-224-5752
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health