Provider Demographics
NPI:1821589458
Name:WILSON, FRANCES EILENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANCES
Middle Name:EILENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRAN
Other - Middle Name:E
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:17 PORTSMOUTH TER
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-2310
Mailing Address - Country:US
Mailing Address - Phone:508-362-1538
Mailing Address - Fax:
Practice Address - Street 1:17 PORTSMOUTH TER
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-2310
Practice Address - Country:US
Practice Address - Phone:508-362-1538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6267-PY-PR103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical