Provider Demographics
NPI:1851576094
Name:DR. SHARON R. WILSON PSYCHOLOGICAL SERVICES
Entity Type:Organization
Organization Name:DR. SHARON R. WILSON PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-922-1566
Mailing Address - Street 1:485 MANSFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-4344
Mailing Address - Country:US
Mailing Address - Phone:412-922-1566
Mailing Address - Fax:412-922-3516
Practice Address - Street 1:485 MANSFIELD AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-4344
Practice Address - Country:US
Practice Address - Phone:412-922-1566
Practice Address - Fax:412-922-3516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005922L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1318479OtherHIGHMARK BC/BS
PA1318479OtherHIGHMARK BC/BS