Provider Demographics
NPI:1689901985
Name:WILSON, LAURA ANN (MS ED)
Entity Type:Individual
Prefix:MS
First Name:LAURA ANN
Middle Name:
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 1:358 7TH AVE # 144
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4315
Mailing Address - Country:US
Mailing Address - Phone:347-581-3722
Mailing Address - Fax:
Practice Address - Street 1:358 7TH AVE # 144
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4315
Practice Address - Country:US
Practice Address - Phone:347-581-3722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-06
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst