Provider Demographics
NPI:1629331061
Name:WILSON, VAL LORIE A (MS ED)
Entity Type:Individual
Prefix:MS
First Name:VAL LORIE
Middle Name:A
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 5TH AVE
Mailing Address - Street 2:34B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-3123
Mailing Address - Country:US
Mailing Address - Phone:917-691-5743
Mailing Address - Fax:
Practice Address - Street 1:535 8TH AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4305
Practice Address - Country:US
Practice Address - Phone:212-787-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist