Provider Demographics
NPI:1609208131
Name:WILSON, AYESHA M (MSW)
Entity Type:Individual
Prefix:
First Name:AYESHA
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 COLUMBIA RD UNIT 255753
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02125-7036
Mailing Address - Country:US
Mailing Address - Phone:857-991-7888
Mailing Address - Fax:617-533-8780
Practice Address - Street 1:551 COLUMBIA RD UNIT 255753
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125-7036
Practice Address - Country:US
Practice Address - Phone:857-991-7888
Practice Address - Fax:617-533-8780
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical