Provider Demographics
NPI:1598018038
Name:WILSON, PAUL R (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:WILSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 UNIVERSITY AVENUE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14605-2825
Mailing Address - Country:US
Mailing Address - Phone:585-535-9115
Mailing Address - Fax:585-419-5468
Practice Address - Street 1:33 UNIVERSITY AVENUE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14605-2825
Practice Address - Country:US
Practice Address - Phone:585-535-9115
Practice Address - Fax:585-922-2583
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY078950104100000X
NY0844701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker