Provider Demographics
NPI:1821260480
Name:WILSON, ROBIN (LCSW #73335)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCSW #73335
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 ENBORG CT UNIT 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2645
Mailing Address - Country:US
Mailing Address - Phone:408-793-2425
Mailing Address - Fax:408-448-1815
Practice Address - Street 1:871 ENBORG CT UNIT 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2645
Practice Address - Country:US
Practice Address - Phone:408-885-6482
Practice Address - Fax:408-885-5376
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA# NA201302101YA0400X
CAASW #234911041C0700X
CA733351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)