Provider Demographics
NPI:1801010533
Name:WILNER, GRACE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:WILNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3004
Mailing Address - Country:US
Mailing Address - Phone:718-768-1262
Mailing Address - Fax:718-788-5636
Practice Address - Street 1:594 3RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-3004
Practice Address - Country:US
Practice Address - Phone:718-768-1262
Practice Address - Fax:718-788-5636
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011305103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical